Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study.

BACKGROUND: Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. METHODS: We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. RESULTS: Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9). CONCLUSION: Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.

Outcome of cesarean section in asymptomatic HIV-1 infection in Kampala, Uganda.

AIM: Sepsis remains a major cause of morbidity and mortality in Mulago Hospital, Kampala, Uganda, following cesarean section (CS). The present study was designed to assess whether asymptomatic HIV infection could be contributing to the increased morbidity following emergency CS in the form of wound and genital tract infection (GTI) with consequent prolonged stay in the hospital. METHODS: Five hundred patients who had undergone emergency lower segment CS had their blood taken to check for HIV-1 serostatus on the first postoperative day. The patients were followed up for evidence of wound sepsis, defined as occult pus discharge on compression of the wound or removal of the closing stitches, GTI and duration of stay in the hospital after the operation. RESULTS: There were 98 (20.5%) HIV-1 seropositive patients. The incidence of postoperative wound sepsis (P = 0.948, 95% confidence interval [CI] 0.56-1.86), GTI (P = 0.339, 95% CI = 0.74-2.39) as well as hospital stay >8 days (P = 0.327, 0.78-2.09) was not statistically significantly different between the infected and non-infected groups. Significant predisposing factors to postoperative morbidity were poor general condition on admission, dehydration, preoperative clinical anemia, and ruptured membranes prior to the operation. CONCLUSION: Asymptomatic HIV-1 was not associated with increased postoperative morbidity following emergency lower segment cesarean section.