A Comparison of the Pregnancy and Labour Outcomes between Nulliparous and Grand Multiparous Pregnancies in the Niger Delta

Objective: A comparative study of the challenges posed by grand multiparous compared to nulliparous women in the antenatal period and in labour.

Study Design: A retrospective comparative study of grand multiparous and nulliparous women at the Niger Delta University, Okolobiri, Nigeria conducted between January 2010 and January 2013.

Results: In the study period 3,125 women delivered in the hospital. The grandmultiparous women were 865 (27.6%) and nulliparas 664 (21.2%) of the total number of deliveries. The mean age for grandmultiparous and nulliparous women was 35.6 ± 3.30 and 26.37 ± 3.86 respectively. The grandmultiparous women were significant of less educational attainment than nulliparous women (X2=6.39, P= 0.01). Mean gestational age at booking for grandmultiparas was 24.50 ± 6.40 weeks and the nulliparas 20.20 ± 7.80 weeks respectively. Gestational age at delivery for grand multiparas and nulliparas were 38.40 ±2.40 weeks and 38.50 ± 2.40 weeks respectively. The packed cell volume at booking for grandmultiparous and nulliparas was 30.6 ± 3.7% and 32.2%respectively. Anemia at booking was more significantly in grand multiparous women compared to the nulligravida X2=7.18, P =0.01). Hypertension was significantly more in grand multiparous than the nulliparous woman X2 =3.90, P=0.04). Grand multiparous women significantly have more gestational diabetes than nulliparous women X2= 14.44, P = 0.00). The grandmultiparous woman had more significantly primary postpartum hemorrhage than the nulliparous woman (X2=5.34, P = 0.00). Cephalopelvic disproportion was significantly more in nulliparous women compared to the grand multiparas (P=0.00). Genital tract injuries were more common in nulliparous than grand multiparous (P= 0.01) Urinary tract infection was more significantly common in nulliparous women compared to grand multiparous women P =0.02). Mean birth weight for grand multiparous and nulliparous was 3.41 ± 0.66 and 3.04 ± 0.59 respectively. The nulliparous woman significantly delivered a low birth weight baby (birth weight < 2500g), (X2 = 6.72, P =0.01). The stillbirth rate for the study was 22.7/1000 live deliveries. Stillbirth(s) were significantly more in multiparous women compared to the nullipas..

Conclusion: Grand multiparous pregnancies are still plagued with an avalanche of complications even when antenatal care and delivery was supervised in tertiary institutions. Good birth preparedness, diligence on the part of both the physician and antenatal subjects is important to achieve a good antenatal outcome.