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Stillbirth and very early neonatal mortality by Robson 10-group classification system: A cross-sectional registry of 80633 births from 16 hospitals in Benin, Malawi, Tanzania and Uganda
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  • Claudia Hanson,
  • Kristi S. Annerstedt,
  • Maria Del Rosario Alsina,
  • Muzdalifat S. Abeid,
  • Hussein Kidanto,
  • Helle Mölsted Alvesson,
  • Andrea Pembe B,
  • Peter Waiswa,
  • Jean-Paul Dossou,
  • Effie Chipeta,
  • Manuela Straneo,
  • Lenka Bekova
Claudia Hanson
Karolinska Institutet Institutionen for global folkhalsa

Corresponding Author:[email protected]

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Kristi S. Annerstedt
Karolinska Institutet Institutionen for global folkhalsa
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Maria Del Rosario Alsina
Karolinska Institutet Institutionen for global folkhalsa
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Muzdalifat S. Abeid
The Aga Khan University - Tanzania
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Hussein Kidanto
The Aga Khan University - Tanzania
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Helle Mölsted Alvesson
Karolinska Institutet Institutionen for global folkhalsa
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Andrea Pembe B
Muhimbili University of Health and Allied Sciences
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Peter Waiswa
Makerere University College of Health Sciences
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Jean-Paul Dossou
CNHU-HKM Centre de Recherche en Reproduction Humaine et en Demographie
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Effie Chipeta
Kamuzu University of Health Science
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Manuela Straneo
Karolinska Institutet Institutionen for global folkhalsa
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Lenka Bekova
Instituut voor Tropische Geneeskunde
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Abstract

Objective: To better understand underlying factors of peripartum mortality we assessed variations in mortality by Robson 10-group classification. Design: Cross-sectional study. Setting: Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda. Population: All women aged 13-49 who gave birth to a live or stillborn baby >1000g between July 2021 and December 2022. Methods: We compared peripartum mortality risk by Robson group and calculated proportional contributions to mortality. We assessed interactions between mortality and Caesarean sections using multivariable logistic regression and post-estimations margins. Main Outcome Measures: Peripartum mortality, defined as intrapartum stillbirths and very early (≤24 hours after birth) neonatal deaths. Results: We included 80 663 babies born to 78 085 women, of which 1 706 were intrapartum stillbirths and 617 very early neonatal deaths. Peripartum mortality was 5.2% (Benin), 1.6% (Malawi), 1.1% (Tanzania), and 3.7% (Uganda). The largest contributor to intrapartum stillbirths (27.8%) and very early neonatal deaths (23.3%) was Robson group 3 (multipara with cephalic term singleton in spontaneous labour) followed by group 10 (preterm birth). Intrapartum stillbirth risk in breech presentation (groups 6 and 7) was 5.1% in nullipara and 11.1% in multipara. A Caesarean section halved the odds of peripartum mortality in breech presentation in primipara (0.46; 95% CI 0.22-0.95). Conclusions: Our findings indicate a high share of peripartum mortality in lower obstetric risk groups and high mortality in breech deliveries and preterm births. This underscores the need to intensify actions to improve labour management.
28 Oct 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
03 Nov 2023Assigned to Editor
03 Nov 2023Submission Checks Completed
03 Nov 2023Review(s) Completed, Editorial Evaluation Pending
03 Nov 2023Reviewer(s) Assigned