Comparison of pregnancy outcome among standard primigra vidae and low parity women delivering at Muhimbili national hospital, Dar es salaam, Tanzania.

Abstract

Background:Primigravidity has been associated with unfavourable pregnancy outcome. The standard primigravidae, a subgroup of primigravidae are known to have better feto-maternal outcome compared to the rest of the primigravidae. There is paucity of data on the standard primigravidae in our setup including their proportion and pregnancy performance. Objective: To determine the proportion of standard primigravid women and compare their pregnancy outcome to women of low parity delivering at Muhimbili National Hospital, Dar es salaam, Tanzania. Methodology: A cross sectional study was conducted from 1 st July, 2007 to 31 st December, 2007 at Muhimbili National Hospital, Dar-es-salaam, Tanzania. All standard primigravidae were identified and recruited on admission, followed by two other women of low parity with similar obstetric characteristics. Data on socio-demography, antenatal and any previous obstetric performance, intra-partum events and fetal outcomes were recorded. Modes of delivery, intrapartum complications, maternal and fetal outcomes between the two groups were then analyzed. Results: The standard primigravidae comprised 7.0 % of the total obstetric population during the study period. Women in the standard primigravid group had a higher emergency CS rate as compared to women oflow parity (22.0% versus 14.8%, p-value 0.014). Major indications for the emergency CS were similar among the two groups except for CPD which was higher in the standard primigravid women (23.1 % versus 12.7%). Other indications were obstructed labour, fetal distress, poor progress and malpositions. Higher rates of oxytocin augmentation during labour and episiotomies were observed in the standard primigravid women as compared to low parity women (61.5% versus 26.7%, p-value 0.00 and 13.9% versus 1.0%, p-value 0.00 respectively). The standard primigravidae had higher rates of prolonged labour (25.7% versus 14.6% p-value 0.03) and fetal distress (11.2% versus 5.5%, p-value 0.04) than the low parity women. Other intrapartum complications like occurrence of intrapartum eclampsia and postpartum haemorrhage were not different in the two groups. The low parity women had significantly higher proportion of severe genital tract injuries than the standard primigravida women (1.7% versus 0.9, p-value 0.038). There were two maternal deaths among the study group, both were in the low parity women. The underlying causes of deaths were obstetric haemorrhage. There were more neonates with Apgar score < 7 at 5th minute among standard primigravidae as compared to low parity women (10.2% versus 3.8%, p-valueO.001). More neonates of standard primigravidae required Neonatal unit admission as compared neonates of low parity women (13.1 % versus 6.3%, p-value 0.00). The proportion of neonatal admission due to birth asphyxia was higher among the standard primigravidae than in the other group (73.2% versus 56.7%, p-value 0.05). Conclusion and Recommendations: This study found the standard primigravidae to have a slightly higher risk of poor pregnancy outcome as compared to low parity women. Thus there is a need for a more aggressive intrapartum monitoring system in this group. There is also a need for a larger study on the performance of standard primigravidae, primigravidae in general and low parity women for a proper risk categorization and earlier planning of delivery. Regular clinical audit in the intrapartum care may help to reduce the higher morbidities among standard primigravidae.