A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of XXXX and failure to progress in low- and middle-income countries.

@entity1 @entity548 @entity281 @entity1162 @entity204
BACKGROUND: This population-based study sought to quantify maternal, fetal, and neonatal morbidity and mortality in low- and middle-income countries associated with @entity1162 and failure to progress (OL/PL/FTP). METHODS: A prospective, population-based observational study of pregnancy outcomes was performed at seven sites in Argentina, Guatemala, India (2 sites, Belgaum and Nagpur), Kenya, Pakistan and Zambia. @entity1 were enrolled in pregnancy and delivery and 6-week follow-up obtained to evaluate rates of OL/PL/FTP and outcomes resulting from OL/PL/FTP, including: maternal and delivery characteristics, maternal and neonatal morbidity and mortality and stillbirth. RESULTS: Between 2010 and 2013, 266,723 of 267,270 records (99.8%) included data on OL/PL/FTP with an overall rate of 110.4/1000 deliveries that ranged from 41.6 in Zambia to 200.1 in Pakistan. OL/PL/FTP was more common in @entity1 aged <20, nulliparous @entity1 , more educated @entity1 , @entity1 with @entity1 >3500g, and @entity1 with a BMI >25 (RR 1.4, 95% CI 1.3 - 1.5), with the suggestion of OL/PL/FTP being less common in preterm deliveries. Protective characteristics included parity of >= 3, having an @entity1 <1500g, and having a BMI <18. @entity1 with OL/PL/FTP were more likely to die within 42 days (RR 1.9, 95% CI 1.4 - 2.4), be infected (RR 1.8, 95% CI 1.5 - 2.2), and have @entity548 antepartum (RR 2.8, 95% CI 2.1 - 3.7) or postpartum (RR 2.4, 95% CI 1.8 - 3.3). They were also more likely to have a stillbirth (RR 1.6, 95% CI 1.3 - 1.9), a neonatal demise at < 28 days (RR 1.9, 95% CI 1.6 - 2.1), or a @entity281 (RR 1.2, 95% CI 1.1 - 1.3). As compared to operative vaginal delivery and cesarean section (CS), @entity1 experiencing OL/PL/FTP who gave birth vaginally were more likely to become infected, to have an infected neonate, to @entity548 in the antepartum and postpartum period, and to die, have a stillbirth, or have a neonatal demise. @entity1 with OL/PL/FTP were far more likely to deliver in a facility and be attended by a physician or other skilled provider than @entity1 without this diagnosis. CONCLUSIONS: @entity1 with OL/PL/FTP in the communities studied were more likely to be primiparous, younger than age 20, overweight, and of higher education, with an @entity1 with birthweight of >3500g. @entity1 with this diagnosis were more likely to experience a maternal, fetal, or @entity204 , antepartum and postpartum @entity548 , and @entity281 . They were also more likely to deliver in a facility with a skilled provider. CS may decrease the risk of poor outcomes (as in the case of antepartum @entity548 ), but unassisted vaginal delivery exacerbates all of the maternal, fetal, and neonatal outcomes evaluated in the setting of OL/PL/FTP.
