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

Abstract

<h4>Objectives</h4>To assess the magnitude, associated factors, and immediate outcomes of nonreassuring fetal heart rate status (NRFHRS) among laboring mothers in Ethiopia.<h4>Design</h4>Systematic review and meta-analysis.<h4>Data sources</h4>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.<h4>Eligibility criteria</h4>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 Unpublished studies were also considered, and studies without abstracts or full texts were excluded.<h4>Data extraction and synthesis methods</h4>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.<h4>Results</h4>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%; <i>P</i>=.98), being primiparas (AOR=2.33; 95% CI: 1.84-2.84; I²=92.66%; <i>P</i>=.00), meconium stained amniotic fluid (AOR=5.97; 95% CI: 3.01-8.93; I²=83.31%; <i>P</i>=.00), mothers who are not referred (AOR=2.65; 95% CI: 3.01-8.93; I²=98.21%; <i>P</i>=.00), and no antenatal follow up (AOR=4.08; 95% CI: 2.79-5.37; I²=97.46%; <i>P</i>=.00) respectively were significantly associated with nonreassuring fetal heart rate in Ethiopia.<h4>Conclusion</h4>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.