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Obstetric determinants of preterm delivery in a regional hospital, Accra, Ghana 2016
Ernest Konadu Aseidu1, Delia Akosua Bandoh1, Donne Kofi Ameme1
1Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Insights
Preterm delivery in Ghana is linked to premature rupture of membranes and hypertensive complications. However, regular antenatal care (ANC) visits can reduce the risk of preterm birth.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Neonatal Outcomes
Background:
- Preterm birth is a leading cause of neonatal mortality globally, with significant long-term health and economic consequences.
- Risk factors for preterm delivery require further investigation in regions like Ghana.
- Understanding obstetric determinants is crucial for mitigating adverse perinatal outcomes.
Purpose of the Study:
- To assess the obstetric determinants of preterm delivery at Greater Accra Regional Hospital in Ghana.
- To identify specific risk factors and protective factors associated with preterm birth in the study population.
Main Methods:
- A 1:2 unmatched case-control study was conducted from October 2015 to May 2016.
- Data were collected from 390 mothers (130 cases of preterm delivery, 260 controls of term delivery) using questionnaires and record reviews.
- Multiple logistic regression analysis was used to determine associations between obstetric factors and preterm delivery.
Main Results:
- Premature rupture of membranes (aOR: 2.3) and pre-eclampsia/eclampsia (aOR: 3.4) were significantly associated with preterm delivery.
- Four or more antenatal care (ANC) visits demonstrated a protective effect against preterm delivery (aOR: 0.2).
Conclusions:
- Premature rupture of membranes and hypertensive complications are identified as key risk factors for preterm delivery.
- Adequate antenatal care (ANC) utilization is a protective factor, highlighting its importance in preventing preterm birth.
- Healthcare providers should focus on identifying and managing these risk factors during ANC to improve maternal and neonatal outcomes.
Background:
Globally, prematurity is a major determinant of morbidity and mortality contributing 30-40% of neonatal mortality. The consequences of preterm deliveries are enormous with developmental and childhood complications as well as high economic and psycho-social burden on the parents (family) and society. Some risk factors include ever having preterm delivery, multiple births and some medical conditions like sexually transmitted infection and urinary tract infections but these have not been ascertained in our study area. Much research into these risk factors is needed in Ghana. We assessed the obstetric determinants of preterm delivery.
Methods:
We conducted a 1:2 unmatched case-control study in Greater Accra Regional Hospital (GARH) -Ridge, a secondary referral facility in Accra, Ghana (from October, 2015 -May, 2016). A case was a mother who delivered between 28 and 36 weeks of gestation (preterm) and a control was a mother who delivered after 37 to 42 completed weeks (term). We used structured questionnaire to collect data, reviewed maternal and foetal records using a checklist. Categorical variables were analysed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regression. Significance level of the strength of association was determined at 95% CI and p-value < 0.05.
Results:
We recruited 390 mothers, 130 had preterm deliveries (cases) and 260 had term deliveries (controls). Experiencing premature rupture of membrane (aOR: 2.3; 95% CI:1.0-5.5), pre-eclampsia/eclampsia (aOR: 3.4; 95% CI: 1.0-11.9) were found to be associated with preterm delivery. However, four or more ANC visit was protective factor for preterm delivery (aOR: 0.2; 95% CI: 0.1-0.4).
Conclusion:
Premature rupture of membrane, hypertensive complications and antepartum haemorrhage were found to be risk factors associated with preterm delivery in Ridge Hospital. Health workforce providing ANC services need to identify risk factors and refer these mothers to the doctor for early management and improved outcome decreasing preterm delivery.
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