ADVERSE FETO-MATERNAL OUTCOMES AND COPING AFTER FETAL LOSS AMONG WOMEN WHO GAVE BIRTH IN SELECTED PUBLIC HOSPITALS IN EASTERN ETHIOPIA

Abstract

Background: Adverse maternal and fetal outcomes remain a significant public health concern, particularly in low- and middle-income countries where inadequate healthcare infrastructure contributes to elevated rates of morbidity and mortality. According to the World Health Organization, approximately 260,000 maternal deaths occurred globally in 2023, with the majority in low-resource settings, alongside an estimated 2 million stillbirths annually. Pregnancy-related complications are the major factors resulting in devastating outcomes, inflicting profound emotional and psychological distress on women and their families. While previous studies in Ethiopia and similar settings have documented adverse feto-maternal outcomes, many have not thoroughly assessed non-obstetric predictors or the long-term psychosocial effects on women. This study seeks to address these by understanding the extent and predictors of adverse feto-maternal outcomes and exploring women’s coping after fetal loss. Methods: A hospital-based cross-sectional mixed-methods study was conducted from October 28, 2023, to March 31, 2024, in six public hospitals in eastern Ethiopia. A Simple random sampling technique was used to select samples among those who gave birth in these health facilities. Six trained midwives collected quantitative data via face-to-face interviews supplemented by a review of medical charts from admission to discharge. Predictors of adverse feto-maternal outcomes were identified using Poisson regression analysis at p<0.05. The qualitative part of the study followed a phenomenological approach with in-depth interviews using a semi-structured tool to study women’s coping strategies following a fetal loss. An interview was conducted at the first and six months after the loss of the fetus to assess their coping mechanism using the "Living with Grief after Pregnancy Loss" model. Coping was described as involving connectedness that facilitate healing. In contrast, disconnectedness, that hinders effective coping and prolongs distress. Data was analyzed using Open Code software through both deductive and inductive approaches based on the five-steps of framework analysis. The trustworthiness of the data was ensured throughout the data collection period. Results: A total of 2,608 women with a mean age of 26 (+5.1 years) participated in the study. The magnitude of adverse maternal and fetal outcomes was 15.68% (95% CI: 14.70%–16.66%) and 26.6% (95% CI: 25.6-27.6), respectively. Low household wealth, having maternal danger signs at admission, alcohol use during pregnancy, prolonged labor, and maternal age above 35 years were associated with adverse maternal outcomes. Folic acid intake during pregnancy, partner support, and spontaneous vaginal delivery were found to be protective of adverse maternal outcomes. Similarly, history of pregnancy complications, maternal anxiety, referral from lower-level health facilities, vii presence of maternal danger signs at admission, and chewing khat during pregnancy were associated with adverse fetal outcomes; while folic acid supplementation was protective. Coping fetal loss (connectedness) was reflected in strong faith in religious, presence of social support, personal resilience for problems, and in cultural acceptance of conditions, whereas blaming God, avoiding support networks, emotional withdrawal, and cultural conflicts were features of disconnectedness. Conclusion: About one in six women and one in four fetus experienced adverse maternal and fetal outcomes, respectively. Existing social networks, religious values, and personal behaviors of withstanding problems influenced maternal coping after fetal loss positively. It is imperative to equip health system with necessary resources to early detect and manage pregnancy related complications, and to have efficient referral pathways. Comprehensive psychosocial support, addressing religious, family, and cultural dimensions is necessary for the women to have a better copying.