Obstetrical risks in the older primigravida.

OBJECTIVE: To compare the complications, delivery mode and fetal outcome between elderly primigravidae and young primigravidae. DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, POFs Hospital, Wah Cantt, from January 2001 to December 2002. SUBJECTS AND METHODS: One hundred and fifty six elderly primigravidae were compared with a matched pair group of younger primigravidae regarding antenatal, intrapartum and postpartum complications. Perinatal mortality was also compared. Specially designed proforma was used to record the information. Data analysis was performed using SPSS package for windows version 10.0. Results were compared using Chi-square test by keeping the p-value of <0.05 as significant. RESULTS: Amongst the complications during pregnancy, pregnancy induced hypertension was commonest complication in elderly primigravidas (24.35% vs. 6.41%, p-value < 0.05). Diabetes, malpresentation and premature labour were also more frequent in elderly group (p-value < 0.05). More (30.76%) of elderly group were delivered by caesarean section as compared to 16.02% in young group (p-value < 0.05). Congenital malformations of the fetus were common in elderly group (5.12% vs. 1.28%). Cases of essential hypertension (12.82% vs. 1.92%), fibroid uterus (9.61% vs 2.56%) and ovarian cyst (7.69% vs. 1.92%) were frequent in elderly group patients. Perinatal mortality was relatively high in elderly groups and compared to young patients and 17 babies in elderly group were still born as compared to 10 babies in young group. CONCLUSION: Advanced maternal age has been associated with an increased risk of various complications like hypertension, diabetes, and intrauterine growth retardation and congenital malformations. Timely and accurately diagnosis of complications and their treatment leads to favorable outcome. The higher rate of caesarean section in older primigravidas is due mainly to higher rate of obstetrical complications.

Outcome of twin pregnancy in booked versus unbooked cases.

OBJECTIVE: To assess the outcome of twin pregnancy in booked versus unbooked cases. DESIGN: Comparative study. PLACE AND DURATION OF STUDY: This study was conducted in Khyber Teaching Hospital, Gynae A unit, Peshawar, over a period of two years from 1st January 1996 to 31st December 1997. SUBJECTS AND METHODS: A total of 96 patients with twin pregnancy were included. The inclusion criteria were all those patients who had completed twenty-eight weeks of pregnancy with twin gestation. Evaluation was done by a detailed history and data was collected. Antenatal, intrapartum and postnatal complications as well as perinatal mortality and morbidity was noted in the two groups. RESULTS: Out of 96 cases, 65 patients were unbooked and 31 patients were booked cases. Majority of the unbooked cases came from rural areas and belonged to age group of 18 to 38 years. The rate of instrumental deliveries was high in unbooked cases (18.46%) as compared to booked cases (9.67%). Obstructed labour (9.23%), abruptio placenta (6.15%) and postpartum haemorrhage (21.35%) were common in unbooked cases. Caesarean section was performed in 25 unbooked cases as compared to 4 booked cases. Similarly, the perinatal mortality was high in unbooked cases with 26.93% of cases requiring admission in nursery and 15.3% were stillborn. CONCLUSION: Twin pregnancy is a high risk pregnancy. Diagnosis before delivery is important. The patient should be provided with sufficient information regarding advantages of regular antenatal visits.