A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries

Margo S. Harrison, Sumera Ali, Omrana Pasha, Sarah Saleem, Fernando Althabe, Mabel Berrueta, Agustina Mazzoni, Elwyn Chomba, Waldemar A. Carlo, Ana Garces, Nancy F. Krebs, K. Michael Hambidge, Shivaprasad S. Goudar, Sm Dhaded, Bhala Kodkany, Richard J. Derman, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Edward A. LiechtyJanet L. Moore, Marion Koso-Thomas, Elizabeth M. McClure, Robert L. Goldenberg

Research output: Contribution to journalReview article

21 Citations (Scopus)

Abstract

Background: This population-based study sought to quantify maternal, fetal, and neonatal morbidity and mortality in low- and middle-income countries associated with obstructed labor, prolonged labor and failure to progress (OL/PL/FTP). Methods: A prospective, population-based observational study of pregnancy outcomes was performed at seven sites in Argentina, Guatemala, India (2 sites, Belgaum and Nagpur), Kenya, Pakistan and Zambia. Women were enrolled in pregnancy and delivery and 6-week follow-up obtained to evaluate rates of OL/PL/FTP and outcomes resulting from OL/PL/FTP, including: maternal and delivery characteristics, maternal and neonatal morbidity and mortality and stillbirth. Results: Between 2010 and 2013, 266,723 of 267,270 records (99.8%) included data on OL/PL/FTP with an overall rate of 110.4/1000 deliveries that ranged from 41.6 in Zambia to 200.1 in Pakistan. OL/PL/FTP was more common in women aged <20, nulliparous women, more educated women, women with infants >3500g, and women with a BMI >25 (RR 1.4, 95% CI 1.3 - 1.5), with the suggestion of OL/PL/FTP being less common in preterm deliveries. Protective characteristics included parity of ≥3, having an infant <1500g, and having a BMI <18. Women with OL/PL/FTP were more likely to die within 42 days (RR 1.9, 95% CI 1.4 - 2.4), be infected (RR 1.8, 95% CI 1.5 - 2.2), and have hemorrhage antepartum (RR 2.8, 95% CI 2.1 - 3.7) or postpartum (RR 2.4, 95% CI 1.8 - 3.3). They were also more likely to have a stillbirth (RR 1.6, 95% CI 1.3 - 1.9), a neonatal demise at < 28 days (RR 1.9, 95% CI 1.6 - 2.1), or a neonatal infection (RR 1.2, 95% CI 1.1 - 1.3). As compared to operative vaginal delivery and cesarean section (CS), women experiencing OL/PL/FTP who gave birth vaginally were more likely to become infected, to have an infected neonate, to hemorrhage in the antepartum and postpartum period, and to die, have a stillbirth, or have a neonatal demise. Women with OL/PL/FTP were far more likely to deliver in a facility and be attended by a physician or other skilled provider than women without this diagnosis. Conclusions: Women with OL/PL/FTP in the communities studied were more likely to be primiparous, younger than age 20, overweight, and of higher education, with an infant with birthweight of >3500g. Women with this diagnosis were more likely to experience a maternal, fetal, or neonatal death, antepartum and postpartum hemorrhage, and maternal and neonatal infection. They were also more likely to deliver in a facility with a skilled provider. CS may decrease the risk of poor outcomes (as in the case of antepartum hemorrhage), but unassisted vaginal delivery exacerbates all of the maternal, fetal, and neonatal outcomes evaluated in the setting of OL/PL/FTP.

Original languageEnglish (US)
Article numberS9
JournalReproductive Health
Volume12
Issue number2
DOIs
StatePublished - Jun 8 2015

Fingerprint

Mothers
Zambia
Population
Pakistan
Infant Mortality
Guatemala
Morbidity
Postpartum Hemorrhage
Maternal Death
Fetal Death
Stillbirth
Kenya
Argentina
Pregnancy Outcome
Parity
Observational Studies
India
Hemorrhage
Pregnancy
Infection

Keywords

  • maternal morbidity
  • maternal mortality
  • neonatal morbidity
  • neonatal mortality
  • obstructed labor
  • stillbirth
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries. / Harrison, Margo S.; Ali, Sumera; Pasha, Omrana; Saleem, Sarah; Althabe, Fernando; Berrueta, Mabel; Mazzoni, Agustina; Chomba, Elwyn; Carlo, Waldemar A.; Garces, Ana; Krebs, Nancy F.; Michael Hambidge, K.; Goudar, Shivaprasad S.; Dhaded, Sm; Kodkany, Bhala; Derman, Richard J.; Patel, Archana; Hibberd, Patricia L.; Esamai, Fabian; Liechty, Edward A.; Moore, Janet L.; Koso-Thomas, Marion; McClure, Elizabeth M.; Goldenberg, Robert L.

In: Reproductive Health, Vol. 12, No. 2, S9, 08.06.2015.

Research output: Contribution to journalReview article

Harrison, MS, Ali, S, Pasha, O, Saleem, S, Althabe, F, Berrueta, M, Mazzoni, A, Chomba, E, Carlo, WA, Garces, A, Krebs, NF, Michael Hambidge, K, Goudar, SS, Dhaded, S, Kodkany, B, Derman, RJ, Patel, A, Hibberd, PL, Esamai, F, Liechty, EA, Moore, JL, Koso-Thomas, M, McClure, EM & Goldenberg, RL 2015, 'A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries', Reproductive Health, vol. 12, no. 2, S9. https://doi.org/10.1186/1742-4755-12-S2-S9
Harrison, Margo S. ; Ali, Sumera ; Pasha, Omrana ; Saleem, Sarah ; Althabe, Fernando ; Berrueta, Mabel ; Mazzoni, Agustina ; Chomba, Elwyn ; Carlo, Waldemar A. ; Garces, Ana ; Krebs, Nancy F. ; Michael Hambidge, K. ; Goudar, Shivaprasad S. ; Dhaded, Sm ; Kodkany, Bhala ; Derman, Richard J. ; Patel, Archana ; Hibberd, Patricia L. ; Esamai, Fabian ; Liechty, Edward A. ; Moore, Janet L. ; Koso-Thomas, Marion ; McClure, Elizabeth M. ; Goldenberg, Robert L. / A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries. In: Reproductive Health. 2015 ; Vol. 12, No. 2.
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title = "A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries",
abstract = "Background: This population-based study sought to quantify maternal, fetal, and neonatal morbidity and mortality in low- and middle-income countries associated with obstructed labor, prolonged labor and failure to progress (OL/PL/FTP). Methods: A prospective, population-based observational study of pregnancy outcomes was performed at seven sites in Argentina, Guatemala, India (2 sites, Belgaum and Nagpur), Kenya, Pakistan and Zambia. Women were enrolled in pregnancy and delivery and 6-week follow-up obtained to evaluate rates of OL/PL/FTP and outcomes resulting from OL/PL/FTP, including: maternal and delivery characteristics, maternal and neonatal morbidity and mortality and stillbirth. Results: Between 2010 and 2013, 266,723 of 267,270 records (99.8{\%}) included data on OL/PL/FTP with an overall rate of 110.4/1000 deliveries that ranged from 41.6 in Zambia to 200.1 in Pakistan. OL/PL/FTP was more common in women aged <20, nulliparous women, more educated women, women with infants >3500g, and women with a BMI >25 (RR 1.4, 95{\%} CI 1.3 - 1.5), with the suggestion of OL/PL/FTP being less common in preterm deliveries. Protective characteristics included parity of ≥3, having an infant <1500g, and having a BMI <18. Women with OL/PL/FTP were more likely to die within 42 days (RR 1.9, 95{\%} CI 1.4 - 2.4), be infected (RR 1.8, 95{\%} CI 1.5 - 2.2), and have hemorrhage antepartum (RR 2.8, 95{\%} CI 2.1 - 3.7) or postpartum (RR 2.4, 95{\%} CI 1.8 - 3.3). They were also more likely to have a stillbirth (RR 1.6, 95{\%} CI 1.3 - 1.9), a neonatal demise at < 28 days (RR 1.9, 95{\%} CI 1.6 - 2.1), or a neonatal infection (RR 1.2, 95{\%} CI 1.1 - 1.3). As compared to operative vaginal delivery and cesarean section (CS), women experiencing OL/PL/FTP who gave birth vaginally were more likely to become infected, to have an infected neonate, to hemorrhage in the antepartum and postpartum period, and to die, have a stillbirth, or have a neonatal demise. Women with OL/PL/FTP were far more likely to deliver in a facility and be attended by a physician or other skilled provider than women without this diagnosis. Conclusions: Women with OL/PL/FTP in the communities studied were more likely to be primiparous, younger than age 20, overweight, and of higher education, with an infant with birthweight of >3500g. Women with this diagnosis were more likely to experience a maternal, fetal, or neonatal death, antepartum and postpartum hemorrhage, and maternal and neonatal infection. They were also more likely to deliver in a facility with a skilled provider. CS may decrease the risk of poor outcomes (as in the case of antepartum hemorrhage), but unassisted vaginal delivery exacerbates all of the maternal, fetal, and neonatal outcomes evaluated in the setting of OL/PL/FTP.",
keywords = "maternal morbidity, maternal mortality, neonatal morbidity, neonatal mortality, obstructed labor, stillbirth, sub-Saharan Africa",
author = "Harrison, {Margo S.} and Sumera Ali and Omrana Pasha and Sarah Saleem and Fernando Althabe and Mabel Berrueta and Agustina Mazzoni and Elwyn Chomba and Carlo, {Waldemar A.} and Ana Garces and Krebs, {Nancy F.} and {Michael Hambidge}, K. and Goudar, {Shivaprasad S.} and Sm Dhaded and Bhala Kodkany and Derman, {Richard J.} and Archana Patel and Hibberd, {Patricia L.} and Fabian Esamai and Liechty, {Edward A.} and Moore, {Janet L.} and Marion Koso-Thomas and McClure, {Elizabeth M.} and Goldenberg, {Robert L.}",
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TY - JOUR

T1 - A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries

AU - Harrison, Margo S.

AU - Ali, Sumera

AU - Pasha, Omrana

AU - Saleem, Sarah

AU - Althabe, Fernando

AU - Berrueta, Mabel

AU - Mazzoni, Agustina

AU - Chomba, Elwyn

AU - Carlo, Waldemar A.

AU - Garces, Ana

AU - Krebs, Nancy F.

AU - Michael Hambidge, K.

AU - Goudar, Shivaprasad S.

AU - Dhaded, Sm

AU - Kodkany, Bhala

AU - Derman, Richard J.

AU - Patel, Archana

AU - Hibberd, Patricia L.

AU - Esamai, Fabian

AU - Liechty, Edward A.

AU - Moore, Janet L.

AU - Koso-Thomas, Marion

AU - McClure, Elizabeth M.

AU - Goldenberg, Robert L.

PY - 2015/6/8

Y1 - 2015/6/8

N2 - Background: This population-based study sought to quantify maternal, fetal, and neonatal morbidity and mortality in low- and middle-income countries associated with obstructed labor, prolonged labor and failure to progress (OL/PL/FTP). Methods: A prospective, population-based observational study of pregnancy outcomes was performed at seven sites in Argentina, Guatemala, India (2 sites, Belgaum and Nagpur), Kenya, Pakistan and Zambia. Women were enrolled in pregnancy and delivery and 6-week follow-up obtained to evaluate rates of OL/PL/FTP and outcomes resulting from OL/PL/FTP, including: maternal and delivery characteristics, maternal and neonatal morbidity and mortality and stillbirth. Results: Between 2010 and 2013, 266,723 of 267,270 records (99.8%) included data on OL/PL/FTP with an overall rate of 110.4/1000 deliveries that ranged from 41.6 in Zambia to 200.1 in Pakistan. OL/PL/FTP was more common in women aged <20, nulliparous women, more educated women, women with infants >3500g, and women with a BMI >25 (RR 1.4, 95% CI 1.3 - 1.5), with the suggestion of OL/PL/FTP being less common in preterm deliveries. Protective characteristics included parity of ≥3, having an infant <1500g, and having a BMI <18. Women with OL/PL/FTP were more likely to die within 42 days (RR 1.9, 95% CI 1.4 - 2.4), be infected (RR 1.8, 95% CI 1.5 - 2.2), and have hemorrhage antepartum (RR 2.8, 95% CI 2.1 - 3.7) or postpartum (RR 2.4, 95% CI 1.8 - 3.3). They were also more likely to have a stillbirth (RR 1.6, 95% CI 1.3 - 1.9), a neonatal demise at < 28 days (RR 1.9, 95% CI 1.6 - 2.1), or a neonatal infection (RR 1.2, 95% CI 1.1 - 1.3). As compared to operative vaginal delivery and cesarean section (CS), women experiencing OL/PL/FTP who gave birth vaginally were more likely to become infected, to have an infected neonate, to hemorrhage in the antepartum and postpartum period, and to die, have a stillbirth, or have a neonatal demise. Women with OL/PL/FTP were far more likely to deliver in a facility and be attended by a physician or other skilled provider than women without this diagnosis. Conclusions: Women with OL/PL/FTP in the communities studied were more likely to be primiparous, younger than age 20, overweight, and of higher education, with an infant with birthweight of >3500g. Women with this diagnosis were more likely to experience a maternal, fetal, or neonatal death, antepartum and postpartum hemorrhage, and maternal and neonatal infection. They were also more likely to deliver in a facility with a skilled provider. CS may decrease the risk of poor outcomes (as in the case of antepartum hemorrhage), but unassisted vaginal delivery exacerbates all of the maternal, fetal, and neonatal outcomes evaluated in the setting of OL/PL/FTP.

AB - Background: This population-based study sought to quantify maternal, fetal, and neonatal morbidity and mortality in low- and middle-income countries associated with obstructed labor, prolonged labor and failure to progress (OL/PL/FTP). Methods: A prospective, population-based observational study of pregnancy outcomes was performed at seven sites in Argentina, Guatemala, India (2 sites, Belgaum and Nagpur), Kenya, Pakistan and Zambia. Women were enrolled in pregnancy and delivery and 6-week follow-up obtained to evaluate rates of OL/PL/FTP and outcomes resulting from OL/PL/FTP, including: maternal and delivery characteristics, maternal and neonatal morbidity and mortality and stillbirth. Results: Between 2010 and 2013, 266,723 of 267,270 records (99.8%) included data on OL/PL/FTP with an overall rate of 110.4/1000 deliveries that ranged from 41.6 in Zambia to 200.1 in Pakistan. OL/PL/FTP was more common in women aged <20, nulliparous women, more educated women, women with infants >3500g, and women with a BMI >25 (RR 1.4, 95% CI 1.3 - 1.5), with the suggestion of OL/PL/FTP being less common in preterm deliveries. Protective characteristics included parity of ≥3, having an infant <1500g, and having a BMI <18. Women with OL/PL/FTP were more likely to die within 42 days (RR 1.9, 95% CI 1.4 - 2.4), be infected (RR 1.8, 95% CI 1.5 - 2.2), and have hemorrhage antepartum (RR 2.8, 95% CI 2.1 - 3.7) or postpartum (RR 2.4, 95% CI 1.8 - 3.3). They were also more likely to have a stillbirth (RR 1.6, 95% CI 1.3 - 1.9), a neonatal demise at < 28 days (RR 1.9, 95% CI 1.6 - 2.1), or a neonatal infection (RR 1.2, 95% CI 1.1 - 1.3). As compared to operative vaginal delivery and cesarean section (CS), women experiencing OL/PL/FTP who gave birth vaginally were more likely to become infected, to have an infected neonate, to hemorrhage in the antepartum and postpartum period, and to die, have a stillbirth, or have a neonatal demise. Women with OL/PL/FTP were far more likely to deliver in a facility and be attended by a physician or other skilled provider than women without this diagnosis. Conclusions: Women with OL/PL/FTP in the communities studied were more likely to be primiparous, younger than age 20, overweight, and of higher education, with an infant with birthweight of >3500g. Women with this diagnosis were more likely to experience a maternal, fetal, or neonatal death, antepartum and postpartum hemorrhage, and maternal and neonatal infection. They were also more likely to deliver in a facility with a skilled provider. CS may decrease the risk of poor outcomes (as in the case of antepartum hemorrhage), but unassisted vaginal delivery exacerbates all of the maternal, fetal, and neonatal outcomes evaluated in the setting of OL/PL/FTP.

KW - maternal morbidity

KW - maternal mortality

KW - neonatal morbidity

KW - neonatal mortality

KW - obstructed labor

KW - stillbirth

KW - sub-Saharan Africa

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U2 - 10.1186/1742-4755-12-S2-S9

DO - 10.1186/1742-4755-12-S2-S9

M3 - Review article

C2 - 26063492

AN - SCOPUS:84977524007

VL - 12

JO - Reproductive Health

JF - Reproductive Health

SN - 1742-4755

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M1 - S9

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