not-yet-known not-yet-known not-yet-known unknown Objective To assess the prevalence of adverse perinatal outcomes - and evaluate the association between intrapartum-related neonatal encephalopathy (IP-NE) and i) emergency referrals and ii) emergency cesarean sections (CS) by obstetric risk factors. Design Cross-sectional with a nested case-control study. Setting Two hospitals in rural Eastern Uganda. Population Women giving birth to a live or stillborn baby weighing >2000 grams between June and December 2022. Methods We used prospectively collected perinatal e-registry data to assess the prevalence of adverse perinatal outcomes. Logistic regression with interaction was used to assess the association between IP-NE and emergency referral and emergency CS across risk groups of hypertensive disorders, antepartum hemorrhage, prolonged/ obstructed labor, and birth weight. Main outcome measures Adverse perinatal outcomes were stillbirths, 24-hour neonatal deaths, and IP-NE (defined as Apgar score <7 at 5 minutes, cord blood lactate ≥5.5 mmol/L, and Thompson score ≥5). Results Of 6,550 births, 10.2% had an adverse perinatal outcome: 3.8% stillbirths, 0.6% neonatal deaths, and 5.7% IP-NE. Adverse outcomes were high among neonates whose mothers had antepartum hemorrhage (31.3%) and prolonged or obstructed labor (27.2%). Emergency referral and CS did not change the association between IP-NE and obstetric risks, except in prolonged or obstructed labor. Without emergency CS, the predicted probability of IP-NE was 0.73 (95% CI: 0.51–0.95); with CS, it decreased to 0.45 (95% CI: 0.39–0.50). Conclusions Neonates born to mothers with obstetric emergencies had low healthy survival rates. Emergency referral and CS showed limited benefits in reducing IP-NE, indicating challenges in accessing appropriate care.

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.