Trends and Factors for Adverse Pregnancy Outcomes of Low-Risk Pregnancy from a Midwife Obstetric Unit in South Africa, 2018–2022

The trend of birth outcomes was recorded in a small number of research from rural South Africa. Using the most recent delivery data from 2018 to 2022, this study aims to measure trends and risk factors for context-specific demographic, obstetric, and antenatal care (ANC) for stillbirth and early neonatal deaths (ENND) of pregnant women who gave singleton births. All pregnant women who gave birth to singletons at Kwadabeka CHC (KCHC) between January 2018 and December 2022 were the focus of a retrospective cohort research. Of the total 4116 women, 60 (1.5%) delivered stillbirths and 4080 had live births. Of them, 36 were ENND, resulting in 8.8 per 1000 live births. Variables that were found to increase are ANC utilization rates from 95.4% in 2018 to a higher rate of 96.4% in 2022 (p < 0.05), who received ANC at KCHC 41.4% in 2018 to 69.6% in 2022 (p < 0.001). Variables that had a declining trend are BBA falling from 5.7% in 2018 to 3.8% in 2022 (p = 0.021) and neonatal PCR positive fell from 4.3% to 2.5 %, respectively (p = 0.001). Women having no ANC care had a higher OR = 33.18 (95% CI:3.6-301.0, p = 0.002), and ANC visits between 1–3 had an OR of 9.6 (95% CI;1.2-75.0, p = 0.03) for ENND. Variables having higher OR for stillbirths are women who had ANC at other PHC facilities (OR = 1.91, 95% CI 1.91-3.32, p = 0.02), women who never had ANC (OR = 11.7, 95% CI:2.9-45.9, p < 0.001) and ANC visits between 1–3 (OR = 4.1, 95% CI:1.38-12.1, p = 0.01). Variables that had lower OR for stillbirths are Pregnant women aged between 30–34 years (OR = 0.15, 95% CI:0.04-0.57, p = 0.005), women without HIV infection (OR = 0.56, 95% CI:0.31-0.89, p = 0.008), without syphilis infection (OR = 0.29, 95% CI:0.09-0.92) and those women had no BBA (OR = 0.16, 95% CI:0.08-0.34, p < 0.001). There were no trends for ENND and stillbirth. However, there were decreasing trends in BBA and PCR positivity rates. There were increasing trends for having ANC and having ANC at KCHC. Having no ANC or lower numbers of ANC visits were the strong risk factors for ENNDs and stillbirths. The other risk factors for stillbirths were maternal age, ANC at other PHC clinics, BBA, HIV, and syphilis infections. We suggest continuing to strengthen and promote early ANC attendance and increasing the number of ANC visits. Further studies are encouraged to identify the quality of ANC and the delivery practices that have been implemented.