Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study

doi:10.21203/rs.3.rs-1617254/v1

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Research Article

Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study

https://doi.org/10.21203/rs.3.rs-1617254/v1

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Background

Apgar score is a practical method of systemically assessing newborn baby immediately after birth to identify those requiring resuscitation and to predict survival in neonatal period. This study was aimed to identify determinant of low fifth minute Apgar score among newborns delivered by Cesarean section.

Methods

An unmatched case control study design was conducted. Cases were newborns with Apgar score of < 7; controls were newborns with an Apgar score of > = 7. The study participants were selected by simple random sampling technique. Data was entered into Epi data version 4.6 and exported to SPSS software version 24. Multivariable logistic regression to identify the independent effect of different factors at P < 0.05.

Result

In this study, factors associated with low Apgar score (LAS) were fetal birth weight < 2.5kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] p = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) p = 0.001, Pregnancy induced hypertension (PIH) (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) p = 0.002, antepartum hemorrhage (APH) (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, type of anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) p = 0.001, meconium stained amniotic fluid (MSAF) (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) p = 0.009 and type of cesarean section (CS) (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) p = 0.019.

Conclusions

Fetal birth weight < 2.5kg, skin incision to delivery time, PIH, APH, type of anesthesia, MSAF and type of CS were independently associated with LAS. Therefore, it was strongly recommended that working on identified risk factors were paramount to improve then neonatal outcomes.

Associated factors

Apgar score

Southern Ethiopia

unmatched case control

Apgar score was initially introduced in 1952 to quickly evaluate the clinical status of newborn infants following delivery [1]. The assessments of Apgar score is usually done twice: once at one minute and at 5th minutes after the birth. However, if there are worries about the baby condition and the first two scores are low, the scoring is also performed at 10, 15 and 20 minutes post-delivery. The 1 minute Apgar score shows the need for immediate resuscitation [2, 3] while the 5th min Apgar score may provide an indication of a neonate’s sustained capacity to survive. Due to this reason, the 5th minute Apgar score is a better predictor of later outcomes [4].

Different factors of low Apgar score have been identified by many literatures [2–4]. Some of these factors are perinatal asphyxia, congenital infections, maternal fever in labor, a diagnosis of chorioamnionitis, and preterm birth [5]. Another study has shown that low Apgar score at birth increases the long-term risk of motor control and perception difficulties, delays of cognitive developmental, learning difficulties, cerebral palsy, attention deficit and repeated seizure attack [6] .

Different interventions have been designed and applied to alleviate problems of child morbidity and mortality. Focused antenatal care service is the crucial interventions to increase maternal and child health’s and to reduce both deaths. Despite these efforts are being made to advance reproductive health service to minimize maternal and child mortality, still there is high neonatal morbidity and mortality [7]. As far as our literature searching showed, there was no study conducted regarding low fifth minute Apgar score and its associated factors among newborns delivered by CS at WSUCSH/our study setting. So the objective of this study was to assess risk factors of low fifth minute Apgar score among newborns delivered by CS at WSUCSH. So, early recognition and management of the risk factors of low Apgar score is importance to reduce neonatal morbidity/mortality and to improve neonatal quality of life.

This unmatched case control study was conducted using simple random sampling technique at WSUCSH among newborns delivered by CS from January 1 to December 30, 2019. Preeclampsia was used to calculate the final sample size as it gave the maximum sample size 329 [110 cases and 219 controls] with the following assumptions [8], 95% confidence interval, 80% power, 2.37 odds ratio, 2:1 controls to case ratio. All newborns delivered after 28 weeks of gestational age by CS at WSUCSH who had the record of Apgar score were included. Whereas data with incomplete documentation (at least three missing value), deliveries of unknown gestational age and newborns with documented gross congenital anomalies were excluded. The checklist prepared in English was used to retrospectively retrieve data from medical charts of the sampled newborns’ mother. One day training was given for data collectors and supervisors about the objective of the study, data collection tool and data collection procedures. Pre-test was carried out on 5% of sample size outside study setting. Data was checked for completeness and consistencies and then it was entered into Epi data version 4.6 and exported to SPSS software version 24 for analysis. A binary logistic regression was conducted to see the association between the dependent and independent variables. All variables with P ‒ value less than 0.25 in the binary logistic regression were included in the multivariable logistic regression. Chi-square test/Fisher’s exact test was used to compare categorical variables between groups. AOR with 95% CI and P < 0.05 were used to measure strength of association.

Personal and Socio‒Demographic Characteristics of Study Participants

A total of 329 participants (110 cases and 219 controls) were included in this study. The mean ages of the mothers of cases and controls were 26.8 (SD = 4.3) and 26.7 (SD = 4.7) years, respectively. 50(45.5%) mothers of cases and 88(40.2%) controls were with in age group 25‒29 years. Age group < = 19 years and > = 30years comprises 2(1.8%) and 33(30.0%) for cases and 6(2.7%) and 67 (30.6%) for controls. Majority of mothers of the cases 100(90.9%) and controls 181(82.6%) groups were in the ethnic group of Wolaita. More than half, 60(54.5%) of cases and 140(63.9%) controls were urban residents. Neither cases nor controls have smoking or alcohol drinking history (Table 1).

Table 1

Personal and socio-demographic factors of mothers who gave birth by CS at WSUCSH Southern Ethiopia from January 1 to December 30, 2019.
Variables	Category	Cases (n = 110)	Controls (n = 219)	Total (%) (n = 329)	p-Value
Variables	Category	Frequency (%)	Frequency (%)	Total (%) (n = 329)	p-Value
Age	<=19	2(1.8)	6(2.7)	8(2.4)	.763
	20–24	25(22.7)	58(26.5)	83(25.2)
	25–29	50(45.5)	88(40.2)	138(41.9)
	>=30	33(30.0)	67(30.6)	100(30.4)
Ethnicity	Wolaita	100(90.9)	181(82.6)	281(85.4)	.132
	Hadiya	3(2.7)	13(5.9)	16(4.9)
	Gamo	7(6.4)	25(11.4)	32(9.7)
Residence	Urban	60(54.5)	140(63.9)	200(60.8)	.100
Residence	Rural	50(45.5)	79(36.1)	129(39.2)	.100

Factors Associated With LAS

Among the total participants more than half, 62 (56.4%) mothers of the cases and 117 (53.4%) of the controls were multigravida while 48 (43.6%) mothers of the cases group and 102 (46.6%) mothers of the controls group were primigravida. Twenty six (23.6%) mothers in cases group and 37 (16.9%) mothers in controls group had premature rupture of membrane (PROM). Regarding the cord prolapse, 13(11.8%) mothers in cases group and 14(6.4%) mothers in controls group had cord prolapse; 22 (20.0%) mothers of the cases and 19 (8.7%) of the controls had ante partum hemorrhage during pregnancy. This study has shown that majority of mothers 103 (93.6%) of cases and 196 (89.5%) of controls had ever got ANC service whereas 7 (6.4%) of cases and 23 (10.5%) of controls had never got ANC service during their pregnancy of the current neonate. Twenty one (19.1%) mothers in cases group and 14 (6.4%) mothers in controls group had meconium stained amniotic fluid (MSAF) ; 30 (27.3%) of the cases and 42 (19.2%) of the controls were born from mothers with history of prolonged second stage of labor. The proportion of women with pregnancy‒induced hypertension was higher in cases 20 (18.2%) than controls 13 (5.9%). (Table 2) shows factors associated with LAS among newborns delivered by CS at WSUCSH from January 1 to December 30, 2019.

Table 2

Determinants of low fifth minute Apgar score among newborns delivered by CS at WSUCSH Southern Ethiopia from January 1 to December 30, 2019.
Variables	Category	Cases (n = 110)	Controls (n = 219)	Total (%) (n = 329)	p-value
Variables	Category	Frequency (%)	Frequency(%)	Total (%) (n = 329)	p-value
PROM	Yes	26(23.6)	37(16.9)	63(19.1)	.143
PROM	No	84(76.4)	182(83.1)	266(80.9)	.143
Cord prolapse	Yes	13(11.8)	14(6.4)	27(8.2)	.091
Cord prolapse	No	97(88.2)	205(93.6)	302(91.8)	.091
APH	Yes	22(20.0)	19(8.7)	41(12.5)	.003*
APH	No	88(80.0)	200(91.3)	288(87.7)	.003*
ANC follow up	Yes	103(93.6)	196(89.5)	299(90.9)	.219
ANC follow up	No	7(6.4)	23(10.5)	30(9.1)	.219
MSAF	Yes	21(19.1)	14(6.4)	35(10.6)	.001*
MSAF	No	89(80.9)	205(93.6)	294(89.4)	.001*
PSSL	Yes	30(27.3)	42(19.2)	72(21.9)	.094
PSSL	No	80(72.7)	177(80.8)	257(78.1)	.094
PIH	Yes	20(18.2)	13(5.9)	33(10.0)	.001*
	No	90(81.8)	206(94.1)	296(90.0)
	No	108(98.2)	215(98.2)	323(98.2)
	No	107(97.3)	217(99.1)	324(98.5)
Type of anesthesia	Spinal	78(70.9)	189(86.3)	267(81.2)	.001*
Type of anesthesia	General	32(29.1)	30(13.7)	62(18.8)	.001*
Type of CS	Elective	71(64.5)	123(56.2)	194(59.0)	.001*
Type of CS	Emergency	39(35.5)	96(43.8)	135(41.0)	.001*
Incision to delivery time	<=3	84(76.4)	209(95.4)	293(89.1)	.001*
Incision to delivery time	> 3	26(23.6)	10(4.6)	36(10.9)	.001*
Induction to delivery time	<=6	71(64.5)	132(60.3)	203(61.7)	.452
Induction to delivery time	> 6	39(35.5)	87(39.7)	126(38.3)	.452
Sex of newborn	Male	60(54.5)	123(56.2	183(55.6)	.780
Sex of newborn	Female	5045.5)	96(43.8)	146(44.4)	.780
Type of gestation	Single	108(98.2)	213(97.3)	321(97.6)	.464
Type of gestation	Multiple	2(1.8)	6(2.7)	8(2.4)	.464
Gestational age	Preterm	2(1.8)	14(6.4)	16(4.9)	.232
	Term	108(98.2)	200(91.3)	308(93.6)	.232
	Post term	0(0.00)	5(2.3)	5(1.5)
Birth weight	< 2.5	1(.9)	19(8.7)	20(6.1)	.021*
	2.5-4.0	99(90.0)	182(83.1)	281(85.4)
	> 4.0	10(9.1)	18(8.2)	28(8.5)
Fetal heartbeat	< 120	4(3.6)	7(3.2)	11(3.3)	.084
	120–160	103(93.6)	189(86.3)	292(88.8)
	> 160	3(2.7)	23(10.5)	26(7.9)
*=statistical significant at p-value < 0.05

Regarding the type of anesthesia, majority 78(70.9) of cases and 189(86.3) of controls were underwent surgery under spinal anesthesia; whereas 32(29.1%) of cases and 30 (13.7%) of controls were undergone surgery under general anesthesia. More than half, 71(64.5%) of mothers in the cases group and 123(56.2%) in the controls group had undergone elective CS whereas 39(35.5%) of mothers in the cases group and 96(43.8%) of mothers in the controls group had underwent emergency CS. 84(76.4%) of mothers in the cases group and 209(95.4%) in the controls group had skin incision to delivery time < = 3 minutes whereas 26(23.6%) in the cases group and ten (4.6%) in the controls group had skin incision to delivery time > 3 minutes. regarding induction to delivery time seventy one (64.5%) in the cases group and 132 (60.3%) had induction to delivery time < = 6 minutes whereas 39 (35.5%) in the cases group and 87 (39.7%) in the controls group had induction to delivery time above six minutes.

The proportion of preterm gestation was 2(1.8%) and 14(6.4%) among cases and controls respectively but the proportion of term gestation was 108(98.2%) among the mothers of cases group and 200(91.3%) among mothers of controls group. One hundred eight (98.2%) of the cases and 213 (97.3%) of controls who were delivered are singletons. The proportion of cases and controls by sex of the newborns was slightly different, where males were relatively higher in proportion among controls 123 (56.2%) than cases 60 (54.5%). The mean gestational age among cases and controls was 39.2 (SD = 1.4) and 39.01(SD = 1.9) respectively. Concerning the birth weight, 1(0.9%) of cases and 19(8.7%) had birth weight of < 2.5kg. The proportion of fetal heartbeat < 120 beats per minute was 4(3.6%) among cases and 7(3.2%) among controls.

Table 2

5.4, Bivariate and Multivariable Analysis Results

The bivariate analysis showed that PIH, APH, ANC, Cord prolapse, PSSL, PROM, MSAF, fetal birth weight, type of anesthesia, type of CS and incision to delivery time were significantly associated with LAS.

The multivariable analysis result showed that the likelihood of developing LAS among neonates born from mothers with PIH was 4.58 times (AOR = 4.58, 95% CI, 1.75‒11.92) more compared with their counter‒parts. Neonates born with MSAF fluid were 3.07 times (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) as likely to have low Apgar score as those born without being meconium stained. Neonates born with low birth weight < 2.5kg were 8.17 times (AOR = 8.17, 95% CI: 1.03 ‒ 64.59) as likely to have LAS compared to those born with normal weight. Regarding the APH, newborns delivered from mothers with APH were approximately four times (AOR = 3.96, 95% CI: 1.75 ‒ 8.94) more likely to develop LAS compared to their counter parts. Moreover, the likelihood of encountering LAS was 3.37 times [AOR = 3.37; 95% CI: 1.72 ‒ 6.62) higher among neonates born under general anesthesia compared to spinal anesthesia. In this study, the higher odds of developing LAS was also observed among neonates born by emergency CS compared to elective CS (AOR = 2.17; 95% CI: 1.13 ‒ 4.15). Similarly, newborn with skin incision to delivery time above three minutes were prone to LAS with an odds ratio of 5.27(AOR = 5.27; 95% CI: 2.20‒12.60). (Table 3) shows bivariate and multivariate analysis of determinant factors of LAS among newborns delivered by CS at WSUCSH from January 1to December 30, 2019.

Table 3

Bivariable and multivariable results of factors associated with low fifth minute Apgar score among newborns delivered by CS at WSUCSH from January 1 to December 30, 2019.
Variables	Category	APGAR SCORE				Odds Ratio		P‒value
		Cases		Controls		COR(95%CI) P‒value	AOR(95%CI)
		N	%	N	%	COR(95%CI) P‒value	AOR(95%CI)
Incision time	> 3	26	23.6	10	4.6	1	1
Incision time	<=3	84	76.4	209	95.4	6.46(2.98‒ 14.00) .000	5.27(2.20‒12.60)	.001*
PIH	Yes	20	18.2	13	5.9	3.52(1.67‒7.38) .001	4.58(1.75‒11.92)	.002*
PIH	No	90	81.8	206	94.1	1	1
Cord prolapse	Yes	13	11.8	14	6.4	1.96(.88‒4.33) .095	1.93(0.77‒4.84)	.095
Cord prolapse	No	97	88.2	205	93.6	1	1
Type of CS	Elective	71	64.5	123	56.2	1	1
Type of CS	Emergency	39	35.5	96	43.8	1.42(.88‒2.28) .146	2.17(1.13‒4.15)	.019*
PSSL	Yes	30	27.3	42	19.2	1.58(.92‒2.70) .095	1.54(0.82‒2.88)	.170
PSSL	No	80	72.7	177	80.8	1	1
PROM	Yes	26	23.6	37	16.9	1.52(.86‒2.67) .144	1.32(0.68‒2.57)	.398
PROM	No	84	76.4	182	83.1	1	1
APH	Yes	22	20.0	19	8.7	2.63(1.35‒5.10) .004	3.96(1.75‒8.94)	.001*
APH	No	88	80.0	200	91.3	1	1
Type of anesthesia	General	32	29.1	30	13.7	2.58(1.47‒4.54) .001	3.37(1.72‒6.62)	.001*
Type of anesthesia	Spinal	78	70.1	189	86.3	1	1
MSAF	Yes	21	19.1	14	6.4	3.45(1.68‒7.10) .001	3.07(1.32‒7.12)	.009*
MSAF	No	89	80.9	205	93.6	1	1
BIRTH WEIGHT	< 2.5	1	.9	19	8.7	10.33(1.36‒78.36).024	8.17(1.03‒64.59)	.046*
	2.5‒4	99	90.0	182	83.1	1	1
	> 4	10	9.1	18	8.2	.979(.43‒2.20)	1.50(.58‒3.85)	.400
ANC follow up	Yes	103	93.6	196	89.5	1.72(.71‒4.15).223	2.72(.91‒8.06)	.07
ANC follow up	No	7	6.4	23	10.5	1	1
*=significantly associated with p‒value < 0.05; Hosmer-Lemeshow, goodness of fit test (.673)

The current study was conducted to assess the prevalence and factors associated with low fifth minute Apgar score among newborns delivered by CS at WSUCSH. The proportion of low fifth minute Apgar score in this study was 26.5% (95% CI: 22.7–31.1). Our study was in line with study conducted at Debre Tabor General Hospital, North Central Ethiopia (28.3%) and Arbaminch General hospital in southern Ethiopia (31.5%) [9, 10]. However, the prevalence of LAS in our study was lower than the prevalence in Jimma zone public hospitals, south west Ethiopia (47.5%) and Iran (58.8%) [11, 12]. This variation might be due to differences in sample size and study setting.

In this study: PIH, type of CS, APH, type of anesthesia, incision to delivery time, meconium stained amniotic fluid and low birth weight (< 2.5kg) were found to be significantly associated with low Apgar score among newborns delivered by CS at WSUCSH.

Type of anesthesia was significantly associated with the risk of developing low Apgar score, accordingly new born whose mothers underwent general anesthesia[AOR = 3.37;95% CI(1.72‒6.62)] showed significant association with LAS, as compared with new born whose mothers underwent spinal anesthesia. This finding is consistent with the study conducted at Arbaminch general hospital, southern Ethiopia[9] and Abbasi Shaheed hospital, Pakistan [13]. This could be explained by anesthetic drugs given during general anesthesia cross the placenta and cause fetal depression.

Those newborns delivered from mothers who underwent emergency CS were about 2.17 times (AOR = 2.17; 95% CI: 1.13 ‒ 4.15) more likely to have LAS than those delivered from mothers whom underwent elective CS. This finding was supported by study conducted at Rabat, Morocco [14]. This might be due to the fact that either most of the mothers come with complications or the decision to for CS might be late after they develop complications.

A data from multivariate analysis also showed that babies born when skin incision to delivery time was above three minutes was 5.27 times (AOR = 5.27; 95% CI: 2.20‒12.60) more likely to have LAS compared to those with skin incision to delivery time < = 3. This is in line with study conducted at Gandhi memorial hospital, Ethiopia[15]. The low Apgar score when skin incision to delivery time is prolonged might be due to decrease in blood pressure because of supine hypotension syndrome or effect of anesthetic drugs. This causes decrease in uteroplacental circulation and causes LAS.

Meconium stained amniotic fluid also had a significant association with the occurrence of low Apgar score. Specifically, newborns delivered with meconium stained amniotic fluid were 3.07 times (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) more likely to develop low Apgar score compared with that of their counter parts. This finding is compatible with studies from Gonder, Northwest Ethiopia[16] and India [17]. This might be due to the reason, newborns delivered from mothers with meconium stained amniotic fluid are more predisposed to aspirate it and fill smaller airways and alveoli in the lung. This can lead to airway obstruction and limited lung movement. Then due to poor gas exchange birth asphyxia evidenced by low Apgar score could occur.

This study revealed that neonates born to mothers with PIH were 4.58 times more likely to have LAS than their counterparts [AOR = 4.58:95% CI (1.75‒11.92)]. This is in line with studies done in Lemlem Karl general hospital, Northern Ethiopia[18], Sweden and India [19, 20] This might be due to, PIH causes placental ischemia. Placenta may bleed or it may begin to separate from the wall of the uterus prematurely. This cause limited transfer of oxygen or nutrients to the fetus. If any of these complications occurs, fetal distress may develop ultimately leads to LAS.

Odds of LAS increased about 3.96 times more comparing newborns from mothers with APH to those who do not have the event (AOR = 3.96 95%CI:1.75‒8.94). This is in line with studies conducted at Addis Ababa, Ethiopia [21], Tigray Ethiopia [22] and Indonesia[8] The possible explanation could be because of the consequence of antepartum bleeding. If APH occurs there will be decreased blood flow from mother to fetus through placenta, so that the hypoxemia can occur in the fetus. This condition can lead to birth asphyxia; this in turn leads to LAS.

Moreover, this study also revealed newborns born with low birth weight were eight times more likely to have LAS AOR = 8.17(95% CI:1.03‒64.59). This study is agreeable with studies done at Asella teaching referral hospital, south eastern Ethiopia [23] and Pakistan [24]. This could be explained by the fact that small babies might suffer difficult breathing and might develop difficulty in cardiopulmonary transition and perinatal asphyxia which predisposes the newborns to different complications including LAS.

The main limitations of this study were: there is information bias due to poor recording and post-delivery factors which may affect Apgar score were not considered.

There are different factors which are the causes of low Apgar score. The findings of this study suggest that skin incision to delivery time, PIH, APH, type of anesthesia being general, type of CS being emergency, low birth weight (< 2.5kg) and MSAF were significantly associated with LAS among newborns delivered by CS at WSUCSH.

AOR: Adjusted Odds Ratio, APGAR: Appearance, Pulse, Grimace, Activity, Respiration, CI: Confidence Interval, COR: Crude Odds Ratio, LAS: Low Apgar score, MSAF: Meconium Stained Amniotic Fluid PIH: Pregnancy Induced Hypertension, PROM: Premature Rupture of Membrane PSSL: Prolonged Second Stage Of labor, WSUCSH: Wolaita Sodo University Comprehensive Specialized Hospital

Ethics approval and consent to participate

All methods were carried out in accordance with relevant guidelines and regulations in the declaration. Our study was conducted from retrospective data and we did not take any sample from the patient. Hence, ethical approval and consent to participate was not applicable. However, any type of original article must be approved by the ethical review committee just only for the purpose of permission. Hence, before conducting the study, ethical approval was obtained from the ethical review committee of the College of Health Science and Medicine, Wolaita Sodo University, under the Ref No: CHSM/ERC/113 (01, February, 2020). Moreover, the official permission letter was obtained from the hospital. Informed written consent was obtained from every participant. The purpose of the study was explained to all participants. The information obtained was kept confidential. The name of any participant was not written so that the collected data remained anonymous. We interviewed women in a private room to maintain participants’ privacy. The participants had the right to interrupt their participation at any time without any cost. The letter of ethical approval committee was uploaded as a supplementary file.

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analyzed during the current study will be available from the corresponding author on reasonable request.

Funding

Wolaita Sodo University College of health sciences and medicine funded for data collection and stationary materials.

Competing interest

The authors declared that we have no conflicts of interest.

Author’s contribution:

BD and MS was involved in the conception, study design, execution, acquisition of data, analysis and interpretation of data, took part in drafting the article or revising it critically for important intellectual content. E.W, A.A, M.A, A.O, A.S, G.D and M.M were involved in study design, execution, data collection and organized overall process. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.

Acknowledgment

We would like to thank Wolaita Sodo University for providing financial support to conduct this project.

Apgar V, James L: Further observations on the newborn scoring system. American journal of Diseases of Children 1962, 104(4):419–428.
Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS: Williams obstetrics, 24e: Mcgraw-hill New York, NY, USA; 2014.
Ehrenstein V: Association of Apgar scores with death and neurologic disability. Clinical epidemiology 2009, 1:45.
Jeganathan R, Karalasingam SD, Hussein J, Allotey P, Reidpath DD: Factors associated with recovery from 1 minute Apgar score < 4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010–2012. BMC pregnancy and childbirth 2017, 17(1):1–12.
Lai S, Flatley C, Kumar S: Perinatal risk factors for low and moderate five-minute Apgar scores at term. European Journal of Obstetrics & Gynecology and Reproductive Biology 2017, 210:251–256.
Stuart A, Olausson PO, Källen K: Apgar scores at 5 minutes after birth in relation to school performance at 16 years of age. Obstetrics & Gynecology 2011, 118(2):201–208.
Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C: Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The lancet 2016, 387(10017):462–474.
Utomo MT: Risk factors for birth asphyxia. Folia Medica Indonesiana 2011, 47(4):211.
Sidamo NB: Determinants of poor apgar score and associated risk factors among neonates after cesarean section in public health facilities of Arba Minch town, Southern Ethiopia. EC Paediatrics 2019, 8:61–70.
Bayih WA, Yitbarek GY, Aynalem YA, Abate BB, Tesfaw A, Ayalew MY, Belay DM, Hailemeskel HS, Alemu AY: Prevalence and associated factors of birth asphyxia among live births at Debre Tabor General Hospital, North Central Ethiopia. BMC pregnancy and childbirth 2020, 20(1):1–12.
Belachew T, Joseph J: Birth asphyxia and associated factors among newborns delivered in Jimma zone public hospitals, Southwest Ethiopia: a cross-sectional study. Journal of Midwifery and Reproductive Health 2018, 6(2):1289–1295.
Nayeri F, Shariat M, Dalili H, Adam LB, Mehrjerdi FZ, Shakeri A: Perinatal risk factors for neonatal asphyxia in Vali-e-Asr hospital, Tehran-Iran. Iranian journal of reproductive medicine 2012, 10(2):137.
Saatsaz S, Moulookzadeh S, Rezaei R, Khani NN: COMPARISON OF NEONATAL APGAR SCORE IN GENERAL ANESTHESIA AND SPINAL ANESTHESIA. 2014.
Benzouina S, Boubkraoui ME-m, Mrabet M, Chahid N, Kharbach A, Elhassani A, Barkat A: Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco. Pan African Medical Journal 2016, 23(1).
Obsa MS, Shanka GM, Menchamo MW, Fite RO, Awol MA: Factors Associated with Apgar Score among Newborns Delivered by Cesarean Sections at Gandhi Memorial Hospital, Addis Ababa. Journal of pregnancy 2020, 2020.
Wosenu L, Worku AG, Teshome DF, Gelagay AA: Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study. PLoS One 2018, 13(9):e0203763.
Gane B, Bhat V, Rao R: Antenatal and intrapartum risk factors for perinatal asphyxia: A case control study. Current Pediatric Research 2013.
Gebremedhin MM, Gebremichael MW, Gebremichael BG, Hailu TA, Gebremeskel GA, Tlaye KG, Meikena HK, Yimer NB: Determinants of low APGAR score in newborns delivered at Lemlem Karl general hospital, Northern Ethiopia, 2018: a case control study. 2020.
Vats K, Paul M: Study of fetal outcome in hypertensive disorders of pregnancy in a tertiary care maternity hospital of Delhi. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2016, 5(11):3773–3778.
Svenvik M, Brudin L, Blomberg M: Preterm birth: a prominent risk factor for low Apgar scores. BioMed research international 2015, 2015.
Mulugeta T, Sebsibe G, Fenta FA, Sibhat M: Risk factors of perinatal asphyxia among newborns delivered at public hospitals in Addis Ababa, Ethiopia: case–control study. Pediatric Health, Medicine and Therapeutics 2020, 11:297.
Tasew H, Zemicheal M, Teklay G, Mariye T, Ayele E: Risk factors of birth asphyxia among newborns in public hospitals of Central Zone, Tigray, Ethiopia 2018. BMC research notes 2018, 11(1):1–7.
Bedie NA, Wodajo LT, Mengesha ST: Magnitude and Determinants of Birth Asphyxia: Unmatched Case Control Study Assela Referral Teaching Hospital, Arsi Zone, Ethiopia. Glob J Reprod Med 2019, 7(1):5556705.
Aslam HM, Saleem S, Afzal R, Iqbal U, Saleem SM, Shaikh MWA, Shahid N: Risk factors of birth asphyxia. Italian journal of pediatrics 2014, 40(1):1–9.

No competing interests reported.

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Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study

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Abstract

Background

Methods

Result

Conclusions

Introduction

Methods And Materials

Results

Personal and Socio‒Demographic Characteristics of Study Participants

Factors Associated With LAS

5.4, Bivariate and Multivariable Analysis Results

Discussion

Limitations Of The Study

Conclusions

Acronyms And Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1