« Determinants of Low Apgars and Intrapartum Stillbirth in 4 Public Hospitals in Kigali; Case Control Study »

Abstract

Background: The feature of Apgar score is to swiftly recapitulate the baby's health and to direct resuscitation. Low Apgar are linked to various antagonistic consequences including asphyxia, needs for intensive care, high risk of neonatal respiratory distress, the requirement for mechanical ventilation, and mortality. The present study aim was to determine the predictors of low Apgar and intrapartum stillbirth which can be used to determine strategies to decrease adverse birth outcomes in Rwanda. Methods: A case-control study by utilizing a pre-established data collection form was conducted. Our study sites consisted of 4 public hospitals in Kigali including 2 district hospitals and 2 referral hospitals. A total number of 770 participants, including 385 cases defined as those whose outcomes are 5-minute Apgar below 7 or stillbirth and 385 controls defined as those whose five-minute Apgar are 7 and above. We used a simple random sampling method to select the study participants. Analysis was performed on Sociodemographic, peripartum and fetal characteristics.

Results: The rate of low Apgar and stillbirths in general was 2.76% for all combined sites of recruitment, the prevalence of low Apgar only was 2.27% and that of stillbirths was 0.48%. Amniotic fluid status (OR=1.75; 95% CI: 1.20-2.56; p=0.003), parity (OR=1.41; 95% CI: 1.03-2.08; p=0.031), birth weight (OR=3.66; 95% CI: 2.20-6.09; p<0.001), intrauterine resuscitation (OR=3.28; 95% CI: 2.18-4.94; p<0.001), extreme prematurity (OR=16.9; 95% CI: 6.67-43.03; p<0.001) were predictors of low Apgar at the fifth minute, and stillbirth from the multivariable analysis. The use of Cardiotocography (CTG) during labor monitoring and education were found

to be protective factors from low Apgar and stillbirth. With Chi-square test, congenital fetal malformations were also found predictors of low Apgar or stillbirth. Conclusion: This study shows that using CTG as a monitoring tool led to better outcomes. Given the adverse impact of the fifth minute low Apgar in neonates and the impact of stillbirth on patients and healthcare professionals, prospective studies are needed in low-resource settings.