Predictors of Intrapartum Stillbirths in Singletons in Six Public Hospitals in the Greater Accra Region, Ghana

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dc.contributor.authorVanotoo, L.A.
dc.date.accessioned2020-07-27T12:42:46Z
dc.date.available2020-07-27T12:42:46Z
dc.date.issued2019-07
dc.descriptionPhD - Public Healthen_US
dc.description.abstractIntroduction . Globally. 2.6 million stillbirths are recorded annually: 50% occur during labour (intrapartum). Ghana records 11,000 stillbirths annually and 40% occur during. labour. The Greater Accra Region records 2000 stillbirths annually: 40 % of them occur intrapartum. An understanding of the contributory factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. Objectives The objectives of this study were to identify contributors to intrapartum stillbirths; explore perceptions about stillbirth from women with experience of intrapartum stillbirth, document views of health professionals about causes and prevention of intrapartum stillbirths and develop a model to predict intrapartum stillbirths. Method This was a retrospective 2: I unmatched case-control study with a qualitative component. The study sample was all deliveries between 1st January to 31st December 2016 in six public hospitals in the Greater Accra Region. Cases were selected through census while controls were selected from the live births using systematic random sampling. Relevant information was retrieved from clinical records for both cases and controls. Thirteen (10%) women from the cases and 14 health workers were purposively selected for in-depth interviews. Bivariate and multi variable data analyses were used to determine association between the variables and intrapartum stillbirth. Qualitative data were analysed by themes using NVIVO II. The Area Under the Receiver Operating Characteristics Curve (AUROq and the Brier Score (BS) were used to identify factors to include in the model to predict intrapartum stillbirths. Approval for the study was obtained from the Ghana Health Service Ethics Review Committee. Results During the study period. there were 36,168 deliveries with 918 stillbirths; 362 (39%) occurred intrapartum. Through the census, 125 cases were identified, in addition, 250 controls and 27 participants were included in the study. Mean age of cases and controls were 28.8= 5.54 and 28.9 ± 6.05 years respectively. Mean gestational age was 36.5 ± 3.95 weeks for cases and 38.8 ± 2.69 weeks for controls; median birth weight was 2. 7kg.± 0.92 for cases and 3.1kg ± 0.65 for controls. The following maternal factors were associated with intrapartum stillbirths: pregnancy-induced hypertension (PIH) (aOR 3.70); antepartum haemorrhage (APH) (aOR, 3.28) and premature rupture of membranes (PROM) (aOR 3.36). The major fetal contributory factor was low gestational age (aOR. 0.86). Service delivery factors included lack of trained health staff, inadequate number of beds, theatre space. Non use of partograph to monitor women in labour and non-auditing of perinatal deaths. Fetal autopsy was not performed on stillbirths. The best model to predict intrapartum stillbirth was the model with combination of maternal (PHI. APH and PROM); fetal (low gestational age) and service delivery (mode of delivery and health provider who conducted the delivery) factors. Conclusions and recommendations Improved management of PIH, APH, PROM and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on monitoring of women during labour. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service (GHS) should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. The best model to predict intrapartum stillbirth is a combination of maternal, fetal and health service delivery factors. Thus, interventions to reduce intrapartum stillbirth must combine maternal, fetal and service delivery factors to make them effective.en_US
dc.identifier.urihttp://ugspace.ug.edu.gh/handle/123456789/35705
dc.language.isoenen_US
dc.publisherUniversity of Ghanaen_US
dc.subjectStillbirthen_US
dc.subjectintrapartumen_US
dc.subjectSingletonsen_US
dc.subjectMaternal Health Careen_US
dc.subjectGhanaen_US
dc.titlePredictors of Intrapartum Stillbirths in Singletons in Six Public Hospitals in the Greater Accra Region, Ghanaen_US
dc.typeThesisen_US

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