Labor at Term

Abstract

Objectives: To compare the obstetric outcome between primigravida andmultigravida presenting in labor at term. Study Design: Cross sectional study. Period: Sixmonths from Jan 2013 to Jun 2013. Setting: Obs/Gynae unit III, Jinnah hospital, Lahore.Patients and methods: 800 patients were included in the study which comprised 400of primigravida and 400 of multigravida. Patients having single, alive fetus with cephalicpresentation at 37-41 weeks were included in the study. Those having recurrent miscarriages,parity >5, antepartum hemorrhage, previous uterine scars and significant medical illness wereexcluded from the study. The data was collected on specially designed proforma. Observationsmode of delivery including the indication of cesarean section or instrumental vaginal deliveryif applicable. Maternal complications such as postpartum hemorrhage along with its cause,retained placenta and uterine inversion were also recorded. Fetal and neonatal observationsincluded CTG abnormalities, oligohydramnios, low birth weight, macrosomia, Apgar score < 7at 5minutes, NICU admission, fresh still birth and early neonatal death. Results: Mean age was25.57+ 3.46 years in primigravida women while it was 25.75 + 3.44 years in multigravida group.CTG abnormalities (15.5% VS 4.25%), instrumental deliveries (9.75% VS 1%), cesarean section(15.25% VS 1%) and postpartum hemorrhage (5.7% VS 1.75%) were commoner in primigravidawomen. In addition, NICU admissions, low birth weight babies and a low Apgar score at5-minute were also commoner in primigravida women. Conclusion: Nulliparous women areat greater risk of labor abnormalities, fetal distress, instrumental deliveries, cesarean section,postpartum hemorrhage and neonatal morbidity. These adverse factors should therefore belooked for and treated well in time.