Late arrival in hospital during labour: any correlation with materno-foetal outcome? The state specialist hospital, Asubiaro, Osogbo Experience.
Background: Late arrival in labour is a common occurrence in my centre, It has been said to be associated with poor maternal and foetal outcome because of the lack of intrapartum materno-foetal monitoring. It gave me a great concern why booked patients should deliver in vehicles in 21st century.
Objectives: Is to determine the relationship between late arrival in Hospital during labour and maternofoetal outcome, and to explore the reasons for the late presentation in labour,
Materials and Methods: It is a prospective observational study. All the patients that presented in second stage of labour (Cervical dilatation of 10cm) and those that delivered in vehicles on their ways to the hospital between February, 2013 to January 2015 were recruited into the study. The mothers and their babies were followed up, till the first 7 days postpartum. The total number of patients, recruited in to the study were 227. The outcome measures were: birth asphyxia, early neonatal deaths (ENND), fresh still births (FSB), special care baby unit (SCBU) admissions. primary postpartum haemorrhage (10 PPH), blood transfusion. genital lacerations, delivery in vehicles and retained placenta.
Results: The total number of patients recruited into the study were 227, 196(86.34%) were booked, while 31 ( 13,66%) were unbooked patients. Fifteen (6.6] %) delivered in vehicles before arrival in the hospital, while 212 (93,39%), delivered within 45 minutes of presentation in the Hospital. Majority of the patients 145 (63.87%) were between age 25 and 34 years and were mostly of the social class III,[151 (66.52%)]. Interestingly most of the patients (218; 96,4%) ascribed the reason for arriving late in labour to avoiding long period of stay in labour, in the hospital to prevent unnecessary obstetrics interventions by health care providers.
Conclusion: The fear of "unnecessary" obstetric interventions in labour and the previous positive experience in vaginal deliveries were the main reasons for late presentation in labour in this study. The incidences of birth before arrival, birth asphyxia and genital lacerations, fresh still births were quite high in these patients. The confidence or trust of the patients towards the health care providers should be well established and sustained during the antenatal care period, so that the patients see the health care givers as companions during labour and not just accoucheurs.
Keywords: Social Class. Birth Before Arrival (BBA), Apgar Score, Perineal tear, Early neonatal deaths (ENND), Fresh still births and Intrapartum eclampsia, Primary Postpartum Heamorrhage.