{
  "abstract": "Introduction Intrapartum-related complications are a leading cause of adverse perinatal outcomes, including stillbirths, neonatal deaths and intrapartum-related neonatal encephalopathy (IP-NE). We assessed the prevalence of adverse intrapartum-related outcomes, evaluated the association between IP-NE and obstetric and fetal risk factors, and examined whether emergency referral and emergency caesarean section (CS) modified this association through interaction effects.Design Cross-sectional with a nested case–control study.Setting Two hospitals in rural Eastern Uganda.Population Women giving birth to a live or stillborn baby weighing >2000 g between June and December 2022.Methods We used prospectively collected perinatal e-registry data to assess the prevalence of adverse perinatal outcomes. Logistic regression with interaction with postregression margins analysis was used to determine the association between IP-NE and emergency referral and emergency CS across risk groups of hypertensive disorders, antepartum haemorrhage, prolonged/obstructed labour and birth weight.Main outcome measures Adverse perinatal outcomes were stillbirths, 24-hour neonatal deaths and IP-NE (defined as Apgar score <7 at 5 min, cord blood lactate ≥5.5 mmol/L and Thompson score ≥5).Results Of 6550 births, 10.2% had an adverse perinatal outcome: 3.8% stillbirths, 0.6% neonatal deaths and 5.7% IP-NE. Adverse outcomes were higher among neonates whose mothers had antepartum haemorrhage (31.3%) or prolonged/obstructed labour (27.2%) compared with those whose mothers had no complications. Emergency referral and CS did not change the association between IP-NE and obstetric risk, except in prolonged/obstructed labour. Without emergency CS, the predicted probability of IP-NE was 0.73 (95% CI 0.51 to 0.95); with CS, it decreased to 0.45 (95% CI 0.39 to 0.50).Conclusions Neonates born to mothers with obstetric complications had low healthy survival rates. Emergency referral and CS did not alter the risks of IP-NE in women with obstetric complications except for obstructed or prolonged labour, highlighting that these interventions may not be implemented with sufficient timeliness or quality, and/or that additional, more targeted strategies beyond referral and CS are needed to address IP-NE.",
  "authors": [
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden",
        "Department of Health Policy Planing and Managment, Makerere University School of Public Health, Kampala, Central Region, Uganda"
      ],
      "name": "Phillip Wanduru"
    },
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden"
      ],
      "name": "Manuela Straneo"
    },
    {
      "affiliations": [
        "London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Samantha Sadoo"
    },
    {
      "affiliations": [
        "London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Cally J Tann"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda"
      ],
      "name": "Angelina Mwesige Kakooza"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda",
        "Iganga Hospital, Iganga, Uganda"
      ],
      "name": "Rolland Mutumba"
    },
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden"
      ],
      "name": "Kristi Sidney Annerstedt"
    },
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden",
        "Department of Health Policy Planing and Managment, Makerere University School of Public Health, Kampala, Central Region, Uganda"
      ],
      "name": "Peter Waiswa"
    },
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden",
        "London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Claudia Hanson"
    }
  ],
  "title": "Prevalence and risk of adverse intrapartum-related outcomes in Uganda: a cross-sectional study with nested case–control",
  "uid": "5bd89ea6-18ef-5067-895f-31843d69386a"
}