Labor at Term; Comparison of Obstetric Outcome Between Primigravida and Multigravida Presenting in Laboartery

Abstract

Patients and methods: 800 patients were included in the study which comprised 400 of primigravida and 400 of multigravida. Patients having single, alive fetus with cephalic presentation at 37-41 weeks were included in the study. Those having recurrent miscarriages, parity >5, antepartum hemorrhage, previous uterine scars and significant medical illness were excluded from the study. The data was collected on specially designed proforma. Observations mode of delivery including the indication of cesarean section or instrumental vaginal delivery if applicable. Maternal complications such as postpartum hemorrhage along with its cause, retained placenta and uterine inversion were also recorded. Fetal and neonatal observations included CTG abnormalities, oligohydramnios, low birth weight, macrosomia, Apgar score < 7 at 5minutes, NICU admission, fresh still birth and early neonatal death. Results: Mean age was 25.57+ 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 primigravida women. In addition, NICU admissions, low birth weight babies and a low Apgar score at 5-minute were also commoner in primigravida women. Conclusion: Nulliparous women are at greater risk of labor abnormalities, fetal distress, instrumental deliveries, cesarean section, postpartum hemorrhage and neonatal morbidity. These adverse factors should therefore be looked for and treated well in time.