Prevalence and factors associated with intrapartum and immediate postpartum obstetric complications in Ethiopia: a secondary analysis of a national longitudinal survey

BACKGROUND: Most maternal deaths in Ethiopia occur during childbirth and the immediate postpartum period, yet population-level evidence on intrapartum and immediate postpartum complications and their determinants remains limited. In particular, the roles of intimate partner violence (IPV) during pregnancy and pregnancy complications have been underexplored. OBJECTIVE: To determine the prevalence and factors associated with intrapartum and immediate postpartum obstetric complications in Ethiopia. METHODS: We conducted a secondary analysis of the Performance Monitoring for Action Ethiopia (PMA-E) longitudinal survey (October 2019 and September 2020) using a two-stage stratified cluster sampling design. Multilevel modified Poisson regression analysis was used to estimate adjusted prevalence ratio (aPR) with 95% confidence intervals (CIs). RESULTS: A total of 2558 women were included in the analysis. The prevalence of intrapartum and immediate postpartum complications was 37.6% and 31.6%, respectively. Rural residence (aPR = 1.72,95% CI: 1.34-2.20), intimate partner violence (IPV) during index pregnancy (aPR = 1.31,95% CI: 1.14-1.50), pregnancy complications (aPR = 1.78, 95% CI: 1.55-2.06), and nulliparity (aPR = 1.30, 95% CI: 1.07-1.58) were associated with intrapartum complications. Factors associated with immediate postpartum complications were complications during pregnancy (aPR = 1.65, 95% CI: 1.40-1.93) and prolonged labour (aPR = 1.34, 95%CI: 1.14-1.57). Childbirth at health facility was associated with a lower prevalence of immediate postpartum complications (aPR = 0.83, 95% CI: 0.70-0.98). CONCLUSION: Intrapartum and immediate postpartum obstetric complications are common in Ethiopia. IPV during pregnancy, pregnancy complications, and nulliparity were associated with intrapartum complications. Pregnancy complications and prolonged labour were associated with a higher prevalence of immediate postpartum complications, while health-facility childbirth was associated with a lower prevalence.