Studying the Birth Outcome in Tikrit Teaching Hospital

Abstract

Background : A successful birth outcome is defined as the birth of a healthy baby to a healthy mother. While relatively low in industrialized world, maternal and fetal morbidity and mortality and neonatal deaths occur disproportionately in developing countries.
Aim of the Study: To assess birth outcome and identify some risk factors affecting it for achieving favorable birth outcome in Tikrit Teaching Hospital.
Objectives of the study :The study was conducted to :
1. Describe the sociodemographic background for the study subjects including maternal age, occupation, education, and smoking habit and their effect on birth outcome.
2. Recognize the extent and the factors which determine the perinatal mortality and morbidity.
3. Measure the frequency of birth outcome among delivered pregnant mothers in Tikrit Teaching Hospital .
4. Identify the effect of antenatal care, residency and mode of delivery on birth outcome.
5. Assess the effect of parity, birth spacing and medical and family history on birth outcome.
6. Find out the effect of fetal factors (including: number of fetuses, and their gender) on the birth outcome.
7. Recognize the benefit of Apgar score and its relationship with birth weight and birth outcome.
Study design: The current work represents a cross sectional study, which included ( 714 ) pregnant women who gave birth in the delivery room in Tikrit Teaching Hospital in Tikrit city, for the period extended from the first of February to the end of July ( 2007 ) . This study was carried out in an attempt to study the birth outcome in Tikrit Teaching Hospital.
A direct interview was done with every included delivered mother and a physical examination was conducted only for their newborn babies.
Results: The outcome of ( 714 ) deliveries was evaluated and to be set as either favorable or unfavorable, it was found that the frequency of favorable outcome was 512 (71.7%) , while those who have unfavorable outcome (defined as having one or more of the following conditions : stillbirth , preterm, birth asphyxia , gross congenital anomaly, birth trauma or low birth weight) , was 202 (28.3 %) .
It was found that the most unfavorable birth outcome was the birth asphyxia which compromised (15.5%) of the conditions. Caput succedaneum was the most encountered birth trauma in the study sample (7%) . The results showed that women from rural areas have more unfavorable outcome than those from urban areas (31%), (22.3%) respectively. Those who have regular antenatal care have better birth outcome than those who have irregular antenatal care or those who never attended any antenatal care facility. Instrumental delivery had more favorable outcome which accounted for (88.9%), but from Caesarean section, elective type was associated with better birth outcome , (90.9 %) of them had favorable birth outcome. It was shown that the maternal age (<19 and ≥ 35 years), low educational level, increased parity, narrow birth spacing, smoking, mother's work were factors that contribute to the unfavorable outcome. Multiple pregnancies had high significant relation with unfavorable birth outcome, (67.7%) of them was unfavorable. It was found that female gender had more favorable outcome, as there were (77.9%) of them showed favorable birth outcome.
There were only (2.2%) of the neonates who had low Apgar score at 10 minutes (≤3). Very low birth weight was significantly associated with low Apgar score . The study found that 45(60.8%) of mothers with chronic medical illnesses had unfavorable birth outcome and 57(81.4%) of family history with inherited disease had unfavorable outcome .
Conclusions :
1. Frequency of favorable birth outcome is more than unfavorable outcome in Tikrit Teaching Hospital which was (71.7%) .
2. Birth asphyxia was the commonest form of unfavorable birth outcome, and formed (15.5%) most external birth trauma encountered was caput succedaneum (81%) and most common gross congenital anomaly was club foot (43%).
3. There is no statistical significance between maternal work status and birth outcome.
4. More favorable birth outcome was found among babies delivered by instrumental mode of delivery which comprised (88.9%). According to C/S, elective mode was associated with more favorable birth outcome and formed (90.9%) than the emergency type.
5. Male gender can be a contributing factor for developing unfavorable birth outcome.
6. Low Apgar scoring had more unfavorable outcome (69.4%) and seen mostly among low birth weight newborns.
7. Teenager mother, smoker mother, lack of antenatal care, rural residency, increased parity, and multiple pregnancy are maternal factors which can lead to unfavorable birth outcome.
The study concluded that there was still relative high percentage of unfavorable birth outcome. Social as well as maternal and fetal factors play an important role in determining the destiny of the pregnancy.