Factors Associated with Oligohydramnios and Related Neonatal Morbidity and Mortality: A Nested Case-Control Study in a Cohort

Objective: To study the factors associated with oligohydramnios and its related neonatal morbidity and mortality. Materials and Methods: This was a 10-year retrospective nested case-control study conducted at a level 2 maternity ward. Given that the prevalence of oligohydramnios ranges between 0.5% and 8%, the sample size of the cases was calculated using the following formula: n = (z/∆)2 × p(1 − p). We selected 20 controls for each case. Data were exported to Excel and analyzed using the Statistical Package for Social Sciences (SPSS) and R Studio 4.1.3 software. The maximal deepest pocket of amniotic fluid or the amniotic fluid index was used to establish the diagnosis. Qualitative variables were described as proportions relative to the total. Data were compared using the chi-square test when normality conditions were met or non-parametric tests otherwise. The significance threshold was set at 0.05. Results: Out of a cohort of 56,775 deliveries, we collected 145 cases of oligohydramnios and 2953 controls. The prevalence of preeclampsia was seven times higher in cases of oligohydramnios (OR = 7.7 [5.12;11.7]). The prevalence of small-for-gestational-age (SGA) fetuses was four times higher in the case group (OR = 4.3 [3.04;6.21]). Oligohydramnios were associated with an increased risk of labor artificial induction and cesarean sections respectively 4.51 ([2.95;6.99]) and 3.41 ([3.03;3.78]). Perinatal asphyxia was nearly three times more frequent in children born in the context of oligohydramnios (OR = 2.7 [1.38;5.30]). Vaginal delivery and SGA were not associated with neonatal morbidity or mortality in cases of oligohydramnios. Conclusion: Oligohydramnios is associated with obstetric pathologies and increased neonatal morbidity and mortality. However, vaginal delivery and labor induction do not impact neonatal morbidity and mortality. The risk of perinatal asphyxia in oligohydramnios requires special monitoring in the delivery room. Further studies on the relationship between fetal heart patterns during and asphyxia in oligohydramnios will need to be conducted.

A Hospital-Based Cross-Sectional Study Assessing the Relation between Time of Birth and Perinatal Outcome

Objectives:?Investigating the relation between perinatal outcomes and?hospital working shifts.?Methods:?We conducted a cross-sectional study at Philippe Maguilen Senghor health center (PMSHC) in Dakar, Senegal from January, 1st?2011 to December, 31th 2018. The study population was comprised of all mothers who had delivered at PMSHC and their newborns after completing 22 weeks of gestation. Time of delivery was?divided into three periods of working hours: morning shift (deliveries occurred between 7 am and 4:59 pm);evening shift from 5 pm to 10:59 pm and night shift from 11?pm to 6:59 am.?Maternal outcomes were assessed by mode of delivery, epsisotomy and perineal injuries.?The Apgar scoring system was used to assess newborns at first minute after they were born. Other adverse perinatal outcomes included fresh stillbirth, neonatal referral and early neonatal death. Data were analyzed using Statistical Package for Social Science software (SPSS 24, Mac version).?Results:?A total of 48,270 mothers and their newborns met eligibility criteria. Caesarean section deliveries were less likely to occur during evening (OR 0.84, 95% CI;0.79?-?0.89, p = 0.001) and night shifts (OR 0.45, CI;0.47?-?0.53, p = 0.001).?Evening shift deliveries had 1.1 the odds of poor perinatal outcome (Apgar score ?- 1.18, p = 0.012). No significant difference was found in the odds of neonate referrals and deaths across the three shifts.?Night shift deliveries had 1.1 the odds of perineal injuries compared to morning shift deliveries (OR 1.11, 95% CI;1.04?- 1.18, p = 0.001, for episiotomy and OR, 1.14;95% CI, 1.04?- 1.26, p = 0.008, for perineal tears). Conclusion:?Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of perineal injuries compared to morning shift.?However, no significant difference was found in the odds of neonate referrals and deaths across the three shifts.?Our findings suggest to set up a Neonatology unit at the CSPMS as well as a perinatal network across the country.

Relation between Obstetric Outcome and Parity

Objectives: To evaluate the prognosis of obstetric complications by parity in a suburban center in Dakar. Patients and Method: We conducted a retrospective and prospective, cross-sectional study that evaluated all women admitted to the Philippe Maguilen Senghor Health Center for the management of their pregnancy (childbirth, abortion, ectopic pregnancy), whether they were primiparous or multiparous. The data for this study covered a 66-month period, from January 1, 2012 to June 30, 2017. Data were entered into our E-perinatal computer database. They were then extracted and analyzed first on Microsoft Excel 2016 and then on SPSS 24, Windows version. Results: Between January 2012 and June 2017, we’ve registered 27,441 patients including 25,905 deliveries, 1415 abortions and 121 ectopic pregnancies. Direct obstetric complications involved 14.1% of our patients. 12.1% multiparous and 17.3% primiparous had at least one direct obstetric complication of World Health Organization (WHO). Antepartum haemorrhage, uterine rupture, ectopic pregnancy, and abortion complications were more common in multipara, whereas prolonged and obstructed labor, preeclampsia, and eclampsia were more common in primiparous women. Postpartum haemorrhage occurred at substantially equal frequencies in both parity groups. We had not found any case of sepsis. Conclusion: Our study confirms that primiparity is a factor that may lead to obstetric complications. However, while some complications were more common in the primiparous, others were exclusive to multiparous when we did not expect it. We also recommend continuing this work by singling out multiparas and large multiparas, in order to better understand the obstetric prognosis linked to parity.