ASSESSMENT OF PREGNANCY OUTCOME IN PRIMIGRAVIDA: COMPARISON BETWEEN BOOKED AND UN-BOOKED PATIENTS
Abstract
Background: Primigravida (PG), defined as a woman who conceives for the first time, is in a high-riskgroup. Objective of this study was to evaluate the pregnancy outcome in booked and un-bookedprimigravida. Methods: This was a hospital based comparative study conducted in Women andChildren Hospital Abbottabad from May 1998 to November 1999. A total of 322 patients wereincluded in the study. Inclusion criteria was all primigravida, both booked as well as un-bookedpatients. Evaluation was done by taking detailed history, clinical examination and relevantinvestigations. Antenatal, intrapartum and postnatal complications were noted in the mothers. Perinatalmorbidity and mortality was assessed in both the groups. Results: Out of 322 cases, 52 patients werebooked and 270 patients were un-booked. Majority of un-booked patients belonged to the rural areasand were from lower socioeconomic group, between the age group of 15–35 years. The rate ofinstrumental deliveries was high (87.5%) in un-booked patients as compared to booked patients(12.5%). Caesarean section rate in un-booked patients was higher (76.5%) as compared to bookedpatients (23.5%). Twenty-three (20%) patients of un-booked group presented in emergency mainlywith obstructed labour. Twenty-two (19.8%) patients had pregnancy induced hypertension, whilefoetuses of 48 (43.2%) patients developed foetal distress. Antipartum haemorrhage was present in 12(10.8%) patients, while prolonged labour with foetal distress was noted in 26 (23.4%) patients in unbooked group. Postpartum haemorrhage and puerperal pyrexia was more common in un-bookedpatients (7.7% and 18.6% respectively). Perinatal mortality was high in un-booked patients (19.5%) ascompared to booked patients. Conclusion: Primigravida are high-risk patients. Comprehensiveantenatal care should be provided in this group of patients to have better maternal and foetal outcome.Keywords: Primigravida, Pregnancy, Outcome, Complications, Women, Antenatal, Maternal, foetalReferences
World Health Organization. The prevalence of anaemia in
woman. A tabulation of available information. Geneva:
WHO;1992.
Jackon DJ, Keel EB, Green SDR, Mokil JCK, Elton RA, Cutting
WAM. Severe anemia in pregnancy: A problem of primigravidae
in rural Ziar. Tren R Soc Trop Med Hyg 1991;85:829–32.
Garn SM, Ridella SA, Petzold AS, Falkner F. Maternal
hematologic levels and pregnancy outcomes. Semin Perinatol.
;5(2):155–62.
Allen LH. Iron deficiency. Increases risk of pre-term delivery.
Nutr Rev 1993;512:49–51.
Elia M. Nutrition. In: Kumar, Clark (eds). Clinical Medicine. 6th
ed. London: Saunders; 2005. p. 237–8.
Harrison KA, Ibeziako PA. Maternal anemia and fetal birth
weight. J. Obstet Gynaecol Br. Commonw 1973;80:798–804.
World Health Organization. Maternal Mortality Ratios and
Rates: a tabulation of available information. 3 edition,
WHO/MCH/MSM/91.6, Geneva; 1991.
Starrs A. Preventing the tragedy of maternal deaths. Report
on the international safe motherhood conference; Nairobi,
Kenya; 1987.
Severity of anaemia and operative mortality and morbidity.
Lancet 1988; 1(8599):1392–3.
Abu-Heija A, Ali AM. Is breech presentation in Nulli parous
women at term an absolute indication for caesarean section? Ann
Saudi Med 2001;21(3-4):190–2.
Hameed N, Ali MG. Maternal blood loss by expansion of
uterine incision at caesarean section–a comparison between
sharp and blunt techniques. J Ayub Med Coll Abbottabad
;16 (3) 47–50.
Stålberg K, Bodestedt A, Lyrenås S, Axelsson O. A narrow
pelvic outlet in creases the risk for emergency cesarean section:
Acta Obstet Gynecol Scand 2006: 2006; 85(7):821–4.
Al-Zirqi 1, Vangen S, Forsen Letal: Effect of onset of labor and
mode of delivery on severe post partum haemorrhage. Am J Obst
Gynecal: 2009;201(3):1–9.
Lotez AO. Causes of death an assessment of global pattern of
mortality around 1985. Word Health Stat Quart 1990;43:91–104.
Korejo R, Jafary N. Perinatal mortality in Jinnah
Postgraduate Medical Centre Karachi; J Pak Med Assoc
;41:151–4.
Glanzner CM, Abdullah MI, Russel IT, Templeton AA.
Postnatal care a survey of patients experiences, Br J
Midwifery 1993;1:67–74.
