Pregnancy outcomes in facility deliveries in Kenya and Uganda: A large cross-sectional analysis of maternity registers illuminating opportunities for mortality prevention

Introduction As facility-based deliveries increase globally, maternity
registers offer a promising way of documenting pregnancy outcomes and
understanding opportunities for perinatal mortality prevention. This study
aims to contribute to global quality improvement efforts by characterizing
facility-based pregnancy outcomes in Kenya and Uganda including maternal,
neonatal, and fetal outcomes at the time of delivery and neonatal
discharge outcomes using strengthened maternity registers. Methods Cross
sectional data were collected from previously strengthened maternity
registers at 23 facilities over 18 months. Pregnancy outcomes were
classified as live births, early stillbirths, late stillbirths, or
spontaneous abortions according to birth weight or gestational age.
Discharge outcomes were assessed for all live births. Outcomes were
assessed by country and by infant, maternal, and facility characteristics.
Maternal mortality was also examined. Results Among 50,981 deliveries,
91.3% were live born and, of those, 1.6% died before discharge. An
additional 0.5% of deliveries were early stillbirths, 3.6% late
stillbirths, and 4.7% spontaneous abortions. There were 64 documented
maternal deaths (0.1%). Preterm and low birthweight infants represented a
disproportionate number of stillbirths and pre-discharge deaths, yet very
few were born at ≤1500g or <28w. More pre-discharge deaths and
stillbirths occurred after maternal referral and with cesarean section.
Half of maternal deaths occurred in women who had undergone cesarean
section. Conclusion Maternity registers are a valuable data source for
understanding pregnancy outcomes including those mothers and infants at
highest risk of perinatal mortality. Strengthened register data in Kenya
and Uganda highlight the need for renewed focus on improving care of
preterm and low birthweight infants and expanding access to emergency
obstetric care. Registers also permit enumeration of pregnancy loss
<28 weeks. Documenting these earlier losses is an important step
towards further mortality reduction for the most vulnerable infants.