Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria

Samuel Adelaiye, Ishaya Wanonyi, Abiodun Adanikin, Abubakar Kadas, Joel Morrupa, Tina Lavin, Abubakar Lamara, Ibrahim Yahaya, Jamilu Tukur, Calvin Chama

Research output: Contribution to journalArticlepeer-review

Abstract

Objective
To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria.

Design
Retrospective observational study.

Setting
A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria.

Population
Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020.

Methods
Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour.

Main outcome measures
Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis.

Results
Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death.

Conclusions
Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions.
Original languageEnglish
Pages (from-to)(In-Press)
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume(In-Press)
Early online date14 Apr 2024
DOIs
Publication statusE-pub ahead of print - 14 Apr 2024

Bibliographical note

© 2024 John Wiley & Sons Ltd.

Funder

This work was funded by MSD for Mothers and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). The funders did not play any role in the study design, collection, analysis and interpretation of the data, in the writing of the report, or in the decision to submit the article for publication.

Keywords

  • CIN
  • epidemiology
  • labour

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