Pregnancy Outcome in Elderly Primigravidae: A 5-year Review in a Tertiary Health Care Institution in Abakaliki, Southeast, Nigeria

Onuchukwu Victor Jude Uchenna¹, Obi Vitus Okwuchukwu¹, Nwafor Johnbosco Ifunanya^1, , Onwe Blessing Idzuinya¹, Ugoji Darlington-Peter Chibuzor¹, Obi Chuka Nobert¹, Ibo Chukwunenye Chukwu¹ and Agu Chidinma Joy²

¹Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria

²Department of Public Health, University of Calabar, Calabar, Nigeria

Cite this paper

Onuchukwu Victor Jude Uchenna, Obi Vitus Okwuchukwu, Nwafor Johnbosco Ifunanya, Onwe Blessing Idzuinya, Ugoji Darlington-Peter Chibuzor, Obi Chuka Nobert, Ibo Chukwunenye Chukwu and Agu Chidinma Joy. Pregnancy Outcome in Elderly Primigravidae: A 5-year Review in a Tertiary Health Care Institution in Abakaliki, Southeast, Nigeria. American Journal of Clinical Medicine Research. 2019; 7(2):44-47. doi: 10.12691/AJCMR-7-2-2

Abstract

Background: Pregnancies in women of advanced maternal age have been historically regarded as high risk pregnancies because of the associated increase in risk of maternal and perinatal morbidity and/or mortality. Hence, there is a need to evaluate the pregnancy outcome of elderly primigravidae in our setting. Aim: To determine the pregnancy outcomes in elderly primigravidae compared to the younger primigravidae at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Method: This was a retrospective case-control study of pregnancy outcomes of 49 elderly primigravidae (case group), who delivered at the hospital over a 5-year period, were compared with those of 98 younger primigravidae (control group) (≤ 34 years old) that delivered during the same period. Data collection was done using a pre-designed proforma; analysis was done using Epi Info 7.2.1 CDC. Result: During the study period, there were 11703 deliveries. The incidence of elderly primigravidity was 0.42%. The mean age of the study group was 36.5 ± 1.7 years and that of the control group was 24.3 ± 4.2 years. Forty-four (89.8%) patients were booked in the study group, while 71 (72.8%) patients were booked in the control group. Elderly primigravidae were more likely to book before 14 weeks’ gestational age compared with younger primigravidae (χ²=33.29, P<0.0001). The average gestational age at delivery for the study group and control group were 39.0 ± 3.7 weeks and 37.0 ± 4.1 weeks respectively. The incidence of malaria infection was higher in the younger control group while in the elderly primigravidae the rate of diabetes mellitus, hypertensive disorders, multiple gestation and anaemia were higher ; but not statistically significant ((p>0.05)). The caesarean section rate in the case group was higher but of no statistical significance (p=0.51). There was no recorded maternal death in both groups. Conclusion: Elderly primigravidity is not uncommon in our environment. Due to the anxiety associated with such pregnancies they were more likely to book earlier than the younger primigravidae. Although they were more likely to have medical complications, the maternal and perinatal outcomes were not statistically different from younger primigravidae.

Keywords

elderly, primigravidae, pregnancy, outcomes, Abakaliki

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Raveendran S, Mohanapu S, Murugaiah Y. Obstetric Outcome in Elderly nulliparous women: a comparative study. Int J. Reprod Contracept Obstet Gynecol 2016; 5(9): 2921-2928.
[2]	Gharoro EP, Igbafe AA. Maternal Age at First Birth and Obstetric Outcome. Niger J. Clin Pract 2002; 5(1): 20-24.
[3]	Suwanvath C., Pinjaroen S. Pregnanacy Outcome in Elderly Primigravida in Songklanagarind Hospital. Songkla. Med J. 1998; 16(2): 57-63.
[4]	Eke AC, Eleje GU. The pregnancy Outcome in Elderly primigravida: Five year review. FIGO 2009.
[5]	Agboola A. Elderly Primigravida. Text book of Obstetrics and Gynaecology for Medical Student.Volume Two. Heinemann Education book (Nig) Plc . Ibadan; 2001: 156-157.
[6]	Okogbenin SA, Okpere E. Age and Reproductive Outcome.In: Okpere E (Ed). Clinical Obstetrics. Revised Edition. Uniben Press, Benin City. 2004: 398-400.
[7]	Cleary-Goldman J. Malone FD, Vidaver J, Ball RH, Nyberg DA, David A et al . Impact of Maternal Age on Obstertric Outcome. Obstet Gynecol 2005; 105(5) 983-990.
[8]	Onoja B, Onoja KO, Ek wempu CC. Obstetric Performance of Elderly primigravida in Jos University Teaching Hospital, Jos, Nigeria. Jos J. Med 2015; 9(1): 30-37.
[9]	Mehta SH, Sokol RJ. Assessment of At-Risk Pregnancy. In Decherney AA(ed) Current Diagnosis and Treatment in Obstetrics and Gynaecology. 11th Edition. McGraw-Hill Medical Publishing Division, New York; 2013: 223-233.
[10]	Ikeanyi EM, Onyiriuka AN. Advanced Maternal Age at the First Pregnancy and Obstetric Performance: A retrospective study. Pacific J. of Med Sci 2014; 13(1): 21-31.
[11]	Onah HE, Eze JN. Trends in the age of Primigravida in Enugu, Nigeria, Trop J. Obstet Gynaecol. 2002; 19: 71-73.
[12]	Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz R. Pregnancy Outcome at Age 40 and Older. Obstet Gynaecol. 1996; 87: 917-922.
[13]	Seoud M, Nassar AH,Usta IM., Melhem Z, Kazma A, Khalil AM. Impact of Maternal Age on Pregnancy Outcome, Am J. Perinatol .2002; 19: 1-7.
[14]	Berkowitz GS, Skovron ML, Lapinsski RH, Berkowitz RL. Delayed Childbearing and the Outcome of Pregnancy. N Engl J. Med. 1990; 322: 659-664.
[15]	Prysak M, Lorenz R, Kisly A. Pregnancy Outcome in Nulliparous Women 35years and Older. Obstet Gynaecol. 1995; 85: 65-70.
[16]	Kirz DS, Dorchester W, Freeman RK. Advanced Maternal Age: The Mature gravida. Am J. Obstet Gynaecol. 1985; 152: 7-12.
[17]	Ales KL, Drusin ML, Santini DL. Impact of Advanced Maternal Age on the Outcome of Pregnancy. Surg Gynaecol Obstet. 1990; 171: 209-216.
[18]	Yasin SY, Beydoun SN. Pregnanacy Outcome at ≥20weeks’ gestation in Women in their 40’s: A Case Control Study. J. Reprod Med. 1998; 33: 209- 213.
[19]	Urquhart DR, Tai C. Obstetric Performance in Elderly Malaysian Primigravida. Asia Oceania J Obstet Gynaecol. 1991; 17: 321-325.
[20]	Ojule JD, Ibe VC, Fiebai PO. Pregnancy Outcome in Elderly primigravidae. Ann Afri Med. 2011; vol 10(3):204-208.
[21]	Edge V, Larose RK. Pregnancy Outcome in Nulliparous Women aged 35 or older. Am J Obstet Gynaecol. 1993; 168: 1881-1885.
[22]	Dhanjal MK. Pre-conception Counselling.In: Edmonds KD (ed). Dewhurst’s Textbook of Obstetrics and Gynaecology.8th Edition. Blackwell Publishing, Inc.UK. 2012: 35-41.
[23]	Tuck SM, Yudkin PL, Turnbull AC. Pregnancy Outcome in Elderly Primigravida with and without a history of infertility. Br J. Obstet Gynaecol. 1988; 95: 230-237.
[24]	Udo AE, Udofia O, Agan TU, Ekabua JE, Ekanem EI. Socio-Demographic Profile of Older first Time Mothers at the University of Calabar Teaching Hospital Calabar, Southern Nigeria. Afri J Trop Med and Med Research 2010; 1(1):44-50.
[25]	National Population Commission (Nigeria) and ICF International, 2014. Nigeria Demographic and Health Survey 2013. Rockville, Maryland, USA: National Population Commission (Nigeria) and ICF International.