Sociodemographic, obstetric and referral determinants of adverse foetal and perinatal outcomes in obstetric emergencies: evidence from referral hospitals in Benin city, Nigeria

Background: Perinatal mortality remains unacceptably high in many low-resource settings, with a substantial proportion of these deaths occurring among women presenting with obstetric emergencies. This study assessed the sociodemographic, obstetric and referral predictors of adverse foetal and perinatal outcomes among women managed for obstetric emergencies in Benin City, Edo State, Nigeria. Methods: This cross-sectional study was conducted across the four largest referral hospitals in Benin City using clinical data obtained from women who received EmONC services. Binary logistic regression was applied to assess associations between patient characteristics and outcome. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (AOR) with 95% CIs for the association between explanatory variables and adverse foetal outcomes. To assess potential effect modification, interaction terms were specified between key maternal risk factors (booking status and referral status) and selected EmONC interventions. Results: Among 526 women presenting with obstetric emergencies, 171 (32.6%) experienced adverse perinatal outcomes. The most frequently provided EmONC interventions were caesarean section (70.0%), parenteral antibiotics (66.4%), and uterotonics (41.4%). After controlling for potential confounders, referral status (AOR 2.11; 95% CI: 1.39–3.20) and booking status (AOR 0.25; 95% CI: 0.15–0.44) were strongly associated with adverse outcomes. Interaction analyses assessing modification of the associations between referral or booking status and adverse foetal and perinatal outcomes, showed no significant effects across any of the interventions evaluated. Conclusions: Strengthening antenatal care utilisation and improving the efficiency and coordination of referral pathways for women requiring EmONC are essential for improving perinatal survival.