Prevalence, risk factors and adverse outcomes for intrapartum related asphyxia amongst newborns from mothers with low risk deliveries in periurban Gambian health facilities: a retrospective cohort study

Introduction: Despite significant progress in perinatal care, intrapartum related asphyxia remains a leading cause of neonatal morbidity and mortality, especially in the poorest regions of the world such as sub-Saharan Africa. The objective of this study is to determine the prevalence, risk factors, and adverse outcomes of intrapartum related asphyxia among low risk health facility based deliveries in The Gambia. Methods: This is a secondary analysis of a randomised clinical trial conducted in western Gambia between October 2017 and May 2021. Women with low risk pregnancies in labour and their live neonates were recruited at two public health facilities. The prevalence, risk factors, and neonatal outcomes of intrapartum related asphyxia, defined as 1 minute Apgar score <7, were determined using descriptive methods, and unadjusted and adjusted logistic regression. Results: Among 6,758 neonates, 257 (3.8%) experienced intrapartum related asphyxia, 93 (36.2%) of them required hospitalisation. The neonatal case fatality rate was 13.9% (34/245) among newborns with intrapartum related asphyxia. Neonatal death (OR=19.56, 95% CI 12.02 to 31.55, p value<0.001) and hospitalisation (OR=11.91, 95% CI 8.90 to 15.90, p value<0.001) were significantly higher among these neonates. Severe intrapartum related asphyxia cases had a significantly high risk of neonatal death (aOR:71.8, 95% CI 36.00 to 140.40, p value<0.001) and hospitalisation (aOR:19.5, 95% CI 10.80 to 35.00, p value<0.001); however, this risk remained considerable even in mild to moderate cases. Adjusted analysis revealed macrosomia as a major modifiable risk factor (aOR: 3.31, 95% CI 1.78 to 6.15, p value<0.001), and several identifiable risk factors such as history of previous stillbirths (aOR: 2.79, 95% CI 1.41 to 5.52, p value=0.003) or miscarriage (aOR: 1.65, 95% CI 1.08 to 2.52, p value=0.02), and primiparity (aOR: 1.69, 95% CI 1.16 to 2.46, p value<0.001). Conclusions: Intrapartum related asphyxia is a major contributor to neonatal morbidity and mortality among low risk pregnant women in peri urban Gambia. A significant proportion of intrapartum related asphyxia is preventable with timely identification of risk factors by improved antenatal and obstetric care followed by appropriate intrapartum management. Availability of adequate equipment, infrastructures, and skilled staff to help neonates breathe at birth are urgently required to reach the Sustainable Development Goal 3.2 of reducing by 2030 neonatal mortality to 12 deaths per 1000 live births.