The Prevalence of Childbirth Adverse Events (AEs) and Related Factors among Yemeni Mothers and Newborns, Al-Sadaka Teaching Hospital, Aden, Yemen: A Hospital-based Cross-sectional Study

Main Article Content

Iman Al- Nakeeb
Amen Ahmed Bawazir


Background: The main objective of this study is to assess the prevalence of adverse events (AEs) and its related factors among mother and newborns during labor in Al-Sadaka Teaching Hospital, Aden City.

Methods: A cross-sectional hospital-based study conducted at Al-Sadaka Teaching Hospital, Aden City among 2526 pregnant women who were consented and eligible to be included in the study. Quantitative date were collected over the study time (180 days on 3-time shifts) by interviewer administered questionnaire and a direct observation of the obstetric interventions during childbirth. Descriptive statistics were performed using the SPSS program and a p-value of <0.05 was considered significant at 95% Confidence Interval (CI). 

Results: A total of 322 adverse event episodes were identified among both mothers and newborns with a prevalence of 12.7% (322/2526) in the study setting. Almost, the majority of the reported AEs were found among mothers (83.2%). Factors such as prolonged second stage labor was found strongly associated with nulliparous mothers during childbirth (P=001), while asphyxia and meconium aspiration as an AEs among newborns were found associated with the performance of episiotomy intervention during childbirth and fundal pressure (P=0.027, P=0.019, respectively).

Conclusions: Prevalence of AEs among mothers and newborns were high in comparison to the international standard. Further nationwide study was recommended to investigate the different factors associated with AEs in health care services in Yemen and to avoid harmful practices as a key mechanism for improving mother safety.

Adverse events, childbirth, labor, women, newborn

Article Details

How to Cite
Nakeeb, I. A.-, & Bawazir, A. A. (2020). The Prevalence of Childbirth Adverse Events (AEs) and Related Factors among Yemeni Mothers and Newborns, Al-Sadaka Teaching Hospital, Aden, Yemen: A Hospital-based Cross-sectional Study. Asian Journal of Pregnancy and Childbirth, 3(2), 55-68. Retrieved from
Original Research Article


1. WHO. Summary of the evidence on patient safety: implications for research: World Health Organization; 2008.
2. Abdullatif AA. The patient safety friendly hospital initiative: An entry point to building a safer health system in the eastern Mediterranean region. In: Vincent G, editor. International Hospital Federation Reference Book. London: Pro-Brook. 2008;18.
3. WHO. World alliance for patient safety: forward programme 2005: World Health Organization; 2004.
4. Pearlman MD. Patient safety in obstetrics and gynecology: An agenda for the future. Obstetrics & Gynecology. 2006;108(5): 1266-1271.
5. WHO. "Maternal mortality": World Health Organization; 2019.
6. Johansen B, Braut B, Schou P. Adverse events related to care in obstetric units. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke. 2007;127(20):2670-2672.
7. WHO. Progress in essential drugs and medicines policy: 1998-1999. World Health Organization: Geneva: World Health Organization; 2000.
8. WHO/IER/PSP. Global priorities for patient safety research. Geneva, Switzerland World Health Organization; 2009.
9. WHO. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.
10. MOH/Aden. Annual Statistical Report: Al sadaka Teaching Hospital, Health Office, Aden Governorate; 2010.
11. MOHCA. National Study on Hospitalisation-Related Adverse Events. ENEAS 2005: Ministry of Health and Consumer Affairs; 2005.
12. Sholkamy H, Khalil K, Cherine M, Elnoury A, Breebaart M, Hassanein N. An observation checklist for facility-based normal labor and delivery practices: The Galaa study. Monographs in Reproductive Health. 2003;5.
13. Galadanci HS. Protecting patient safety in resource-poor settings. Best Practice & Research Clinical Obstetrics & Gynaeco-logy. 2013;27(4):497-508.
14. Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: Population based review of medical records. BMJ. 2000;320(7237): 741-744
15. Dolan MS, Rouse DJ. The need for evidence-based Obstetrics and Gyneco-logy. Clinical Obstetrics and Gynecology. 1998;41(2):233-234.
16. Sousa P, Uva AS, Serranheira F, Nunes C, Leite ES. Estimating the incidence of adverse events in Portuguese Hospitals: A contribution to improving quality and patient safety. BMC Health Services Research. 2014;14(1):311.
17. Soop M, Fryksmark U, Köster M, Haglund B. The incidence of adverse events in Swedish hospitals: A retrospective medical record review study. International Journal for Quality in Health Care. 2009;21(4):285-291.
18. Najjar S, Hamdan M, Euwema MC, Vleugels A, Sermeus W, Massoud R, et al. The global trigger tool shows that one out of seven patients suffers harm in Palestinian Hospitals: Challenges for launching a strategic safety plan. Inter-national Journal for Quality in Health Care. 2013;25(6):640-647.
19. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal. 2004;170(11):1678-1686.
20. Nuckols TK, Bell DS, Liu H, Paddock SM, Hilborne LH. Rates and types of events reported to established incident reporting systems in two US hospitals. BMJ Quality & Safety. 2007;16(3):164-168.
21. Schiøler T, Lipczak H, Pedersen BL, Mogensen T, Bech K, Stockmarr A, et al. Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskrift for Laeger. 2001;163(39):5370-5378.
22. Aboul Fotouh A, Ismail N, Ez Elarab H, Wassif G. Assessment of patient safety culture among health-care providers at a teaching hospital in Cairo, Egypt. EMHJ. 2012;18(4):372-377.
DOI: 10.26719/2012.18.4.372
23. Belghiti J, Kayem G, Dupont C, Rudigoz R-C, Bouvier-Colle M-H, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: A population-based, cohort-nested case–control study. BMJ Open. 2011;1(2): e000514.
24. Tasneem F, Sirsam S, Shanbhag V. Clinical study of post-partum haemorrhage from a teaching hospital in Maharashtra, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2366-2369.
25. Ngwenya S. Postpartum hemorrhage: Incidence, risk factors and outcomes in a low-resource setting. International Journal of Women's Health. 2016;8:647.
26. López-García LF, Ruiz-Femández DP, Zambrano-Cerón CG, Rubio-Romero JA. Incidence of postpartum hemorrhage based on the use of uterotonics. Maternal outcomes in an intermediate complexity hospital in Bogotá, Colombia; 2016. Revista Colombiana de Obstetricia y Ginecología. 2017;68(3):218-227.
27. Un Nisa M, Aslam M, Ahmed SR, Rajab MT, Nawaz R, Shamim R. Primary postpartum hemorrhage, still a big challenge in developing world (Experience in Tertiary care Hospitals, KSA versus Pakistan). Annals of King Edward Medical University. 2012;18(1):17-17.
28. Gani GN, Ali AT. Prevalence and factors associated with maternal postpartum haemorrhage in Khyber agency, Pakistan. Journal of Ayub Medical College Abbottabad. 2013;25(1-2):81-85.
29. Goonewardene M, Silva C, Medawala M, Karunarathna S. The occurrence, manage-ment and outcomes of post partum haemorrhage in a teaching hospital in Sri Lanka. Sri Lanka Journal of Obstetrics and Gynaecology. 2013;34(4).
30. Yousef F, Haider G. Postpartum hemorrhage an experience at tertiary care hospital. J Surg Pak Int. 2009;14:80-84.
31. El Badawy A, Waly E, Zaitoun N, Abo-Elwan Y. Assessment of Risk Factors for Primary Postpartum Hemorrhage at Zagazig University Hospitals. Zagazig University Medical Journal. 2017;23(2):1-9.
32. Temesgen M. Magnitude of postpartum hemorrhage among women delivered at Dessie Referral Hospital, South Woll, Amhara Region, Ethiopia. J Women's Health Care. 2017;6(391):2167-0420.
33. Cheng YW, Shaffer BL, Bryant AS, Caughey AB. Length of the first stage of labor and associated perinatal outcomes in nulliparous women. Obstetrics & Gynecology. 2010;116(5):1127-1135.
34. Harrison MS, Ali S, Pasha O, Saleem S, Althabe F, Berrueta M, et al. A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low-and middle-income countries. Reproductive Health. 2015;12(S2):S9.
35. Raman TR, Jayaprakash D. Neonatal outcome in meconium stained deliveries-A prospective study. Medical Journal Armed Forces India. 1997;53(1):15-18.
36. Lansky S, França E, Leal MDC. Mortes perinatais evitáveis em Belo Horizonte, Minas Gerais, Brasil, 1999. Cadernos de Saúde Pública. 2002;18:1389-1400.
37. Aquino TDA, Guimarães MJB, Sarinho SW, Ferreira LOC. Fatores de risco para a mortalidade perinatal no Recife, Pernambuco, Brasil, 2003. Cadernos de Saúde Pública. 2007;23:2853-2861
38. Lisonkova S, Janssen PA, Sheps SB, Lee SK, Dahlgren L. The effect of maternal age on adverse birth outcomes: Does parity matter? Journal of Obstetrics and Gynaecology Canada. 2010;32(6):541-548.
39. Getahun D, Lawrence JM, Fassett MJ, Strickland D, Koebnick C, Chen W, et al. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes. American Journal of Obstetrics and Gynecology. 2009;201(4): 378,e1-e6.
40. 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. BMC Research Notes. 2018; 11(1):496.
41. Moiety FMS, Azzam AZ. Fundal pressure during the second stage of labor in a tertiary obstetric center: A prospective analysis. Journal of Obstetrics and Gynaecology Research. 2014;40(4):946-953.
42. Hughes J. Episiotomy: Ritual genital mutilation in western obstetrics. JAMA. 2005;293:2141-2148.
43. Furrer R, Schäffer L, Kimmich N, Zimmermann R, Haslinger C. Maternal and fetal outcomes after uterine fundal pressure in spontaneous and assisted vaginal deliveries. Journal of Perinatal Medicine. 2016;44(7):767-772.
44. Sturzenegger K, Schäffer L, Zimmermann R, Haslinger C. Risk factors of uterine rupture with a special interest to uterine fundal pressure. Journal of Perinatal Medicine. 2017;45(3):309-313.
45. Kitila S, Gmariam A, Molla A, Nemera G. Utilization of partograph during labour and birth outcomes at Jimma University. Journal of Pregnancy and Child Health. 2014;1(101):2.
46. Leal MdC, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, et al. Obstetric interventions during labor and childbirth in Brazilian low-risk women. Cad. Saúde Pública. 2014;30.
47. WHO. Care in normal birth: A practical guide: Technical Working Group, World Health Organization. Report No.: 0730-7659; 1997.
48. Miller S, Tudor C, Thorsten V, Craig S, Le P, Wright L, et al. Maternal and neonatal outcomes of hospital vaginal deliveries in Tibet. International Journal of Gynecology & Obstetrics. 2007;98(3):217-221.
49. Qian X, Smith H, Zhou L, Liang J, Garner P. Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views. BMC Pregnancy and Childbirth. 2001;1(1):1.