# Magnitude, associated factors, and immediate outcomes of nonreassuring fetal heart rate status among laboring mothers in Ethiopia: a systematic review and meta-analysis

## TL;DR

This study reviews the frequency and causes of abnormal fetal heart rates during labor in Ethiopia, highlighting risk factors and poor outcomes for mothers and babies.

## Contribution

The study provides a systematic review and meta-analysis of nonreassuring fetal heart rate status in Ethiopia, identifying key risk factors and outcomes.

## Key findings

- The pooled magnitude of nonreassuring fetal heart rate in Ethiopia is 23.29%.
- Factors like labor augmentation and lack of antenatal care significantly increase the risk of nonreassuring fetal heart rate.
- Nonreassuring fetal heart rate is linked to adverse outcomes such as neonatal ICU admission and perinatal death.

## Abstract

To assess the magnitude, associated factors, and immediate outcomes of nonreassuring fetal heart rate status (NRFHRS) among laboring mothers in Ethiopia.

Systematic review and meta-analysis.

Data were extracted from published articles identified by searching using major bibliographic databases such as PubMed/Medline, Cochrane Library, Virtual Health Library (VHL) Regional Portal, HINARI (research4life), and Google Scholar.

The meta-analysis included all observational studies on NRFHRS among laboring mothers in Ethiopia published in English between 2010 and 2024. Unpublished studies were also considered, and studies without abstracts or full texts were excluded.

Using PRISMA standards, we systematically reviewed and meta-analyzed articles from PubMed, Cochrane Library, and Google Scholar. Q and I2 tests were used to assess heterogeneity across studies. To evaluate the national magnitude and effect size of the linked covariates, a weighted inverse variance random effects model was used. Funnel plots and Egger regression tests were used to examine publication bias. Sensitivity analysis was also performed to determine the impact of the studies.

The analysis included 10 studies with 5949 participants used in the analysis. The pooled magnitude of nonreassuring fetal heart rate (NRFHR) in Ethiopia was 23.29% (14.89, 31.69) augmentation of labor (AOR=3.8; 95% CI: 2.51–5.10; I2=0.00%; P=.98), being primiparas (AOR=2.33; 95% CI: 1.84–2.84; I2=92.66%; P=.00), meconium stained amniotic fluid (AOR=5.97; 95% CI: 3.01–8.93; I2=83.31%; P=.00), mothers who are not referred (AOR=2.65; 95% CI: 3.01–8.93; I2=98.21%; P=.00), and no antenatal follow up (AOR=4.08; 95% CI: 2.79–5.37; I2=97.46%; P=.00) respectively were significantly associated with nonreassuring fetal heart rate in Ethiopia.

The magnitude of the NRFHR in Ethiopia remains high, worsened by factors such as labor augmentation, primiparity, meconium-stained amniotic fluid, and lack of antenatal care follow-up, which are associated with adverse outcomes. These include heightened risks of neonatal intensive care unit admission, low Appearance, Pulse, Grimace, Activity, and Respiration scores, perinatal death, and a greater likelihood of needing caesarean section. The critical need for vigilant monitoring and timely intervention is evident to enhance the health of maternal and neonatal outcomes in such cases.