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

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Abstract Background: Mothers of advanced age, defined as pregnant women aged ≥35years 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 ≥35years 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 structured 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). We identified factors associated with adverse outcomes using modified Poisson regression. Results: Out of 427 participants, most were aged 35-37 years (n=206; 49.4%), and multiparous (n=157; 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 hours (aPR=2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR=2.01, 95%CI: 1.34-3.9). Conclusion: The rate of adverse maternal outcomes was high, with approximately one-third of the advanced-aged mothers surveyed affected. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes compared to their counterparts. We recommend implementation of targeted interventions, emphasizing proper management of labor, close monitoring of hypertensive mothers, and a deliberate effort to avoid both prolonged and precipitate labor, to mitigate risks of adverse outcomes within this study population.

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