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Antepartum Risk Stratification and Its Influence on Labour Interventions and Outcomes: A Retrospective Cohort Study
T Kuku-Kuye1,2, A M Olumodeji1,2, O C Oyebode1
1Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria.
West African Journal of Medicine
|October 6, 2025
Summary
Identifying high-risk pregnancies early is crucial for better maternal and neonatal health. This study in Nigeria found high-risk pregnancies led to more interventions and complications, emphasizing the need for robust antenatal care.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health in LMICs
Background:
- High-risk pregnancies significantly contribute to maternal mortality, especially in low- and middle-income countries (LMICs).
- Early identification of pregnancy risk factors is vital for improving maternal and neonatal outcomes.
- This study investigates antepartum risk stratification's impact on labor interventions and outcomes in Lagos, Nigeria.
Purpose of the Study:
- To examine the influence of antepartum risk stratification on labor interventions and outcomes.
- To identify factors associated with high-risk pregnancy classification.
- To assess the impact of high-risk pregnancies on neonatal outcomes.
Main Methods:
- Retrospective cohort study of 507 women at Lagos State University Teaching Hospital (May 2019-April 2022).
- Classification into low-risk or high-risk based on antenatal clinical profiles (sociodemographic, obstetric, medical factors).
- Analysis of labor interventions (induction, augmentation, delivery mode) and neonatal outcomes (APGAR, NICU admissions) using descriptive statistics, chi-square, and logistic regression.
Main Results:
- High-risk pregnancies (17.6%) were linked to younger maternal age, nulliparity, and higher antenatal care (ANC) utilization.
- High-risk women experienced significantly higher rates of induction (14.6% vs. 1.2%), oxytocin augmentation (27% vs. 5.3%), and emergency cesarean delivery (39.3% vs. 23.4%).
- Neonates from high-risk pregnancies had lower APGAR scores and substantially higher NICU admissions (25.8% vs. 3.8%, p < 0.001).
Conclusions:
- High-risk pregnancies are strongly associated with increased maternal and neonatal complications.
- Early risk stratification and adherence to World Health Organization (WHO) guidelines for antenatal care (ANC) are critical.
- Strengthening ANC services and timely interventions are essential for improving outcomes in LMICs.
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