outcome pf pregnancy in elderly primigravidas

To investigate the effect of advancing age of 35 years and more [elderly primigravida] on the outcome of pregnancy in nulliparous women and to compare the type of complications observed in this group of women to those in the age of 20-34 years. This was a retrospective analysis of 2517 primigravidas delivered at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia between 1996-2000. All were consecutive patients. The data were collected from the records of the labor room and the medical records were screened for maternal age, antenatal complications, gestational age, birth-weight of the neonate, sex of the neonate and the Apgar score. Three-hundred and sixty-two nulliparous were below the age of 19 years; hence, excluded from the study group. Between age of 20-34 years [Group A] there were 1950 patients with the mean age of 24.79 years [range 20-34] and in women over the age of 35 years [Group B] there were 205 patients with the mean age of 38.72 years [range 35-48 years]. Group B had significantly less number of normal deliveries 59.9 compared to group A 81% with p value of <0.001. Diabetes mellitus was common in group B as compared to group A and was statistically significant at p value <0.001. The gestational age in group B was 36.06 weeks and in group A it was 38.84 weeks [p value was markedly significant at <0.001]. Women in group B had more deliveries by cesarean section [CS] 23.8% as in group A 12.6%, a significant p value <0.001. The Apgar score at 1 and 5 minutes was significant at p value <0.001 and <0.004. The birth-weight in group B was less compared to group A, p value of <0.002. Childbearing in elderly primigravidas does have higher rates of complications due to diseases such as diabetes mellitus and preeclamptic toxemia. They are liable to have more deliveries by CS than by other methods, in spite of lower gestational age and birth weight. The overall outcome however does not appear grim, as was once believed. This study suggests that women in the age group of >35 years should be informed of their pregnancy expectations and outcomes

Neural tube defects in newborns

To study the incidence of neural tube defect [anencephaly, spina bifida cystica and encephalocele] in patients delivered at the Princess Badeea Teaching Hospital in Broth Jordan, and to discuss the possible ways to reduce them. We reviewed all cases of neural tube defects referred to, and delivered at this main referral hospital in the North of Jordan between 1st of January 1995 and 31st of December 1996. During the study period, there were 55 cases of neural tube defects [2.91000 birth], of these 26 cases of spina bifida cystica [1.36/1000], 10 cases of encephalocele [0.52/1000], and 19 cases of anencephaly [0.99/1000]. The overall female to male ratio was 1:0.77. The mot common site of spina bifida was the dorsolumbar in 13 [50%], lumbosacral 5 [19.3%], cervical 4 [15.4%], lumbar 3 [11.5%]. There were 10 cases 10 cases of encephalocele, in 9 [90%] cases the encephalocele was occipital. Five [50%] cases of encephalocele was associated with other malformations while 19 [73%] of spina bifida cases were associated with other malformations. The incidence of neural tube defects is high because of increased awareness, and antenatal diagnosis of neural tube defect. We able to reduce such by advising women in the childbearing age to take daily vitamins which contain folic acid before they become pregnant

Correlation of decrease in cesarean section rates and decrease in perinatal mortality at Princess Basma teaching hospital in north Jordan

A great effort has been made to reduce cesarean section rates at Princess Basma Teaching Hospital in North Jordan. This hospital is the main central and referral hospital in North Jordan with the annual deliveries about 8250. The cesarean section rate has declined from 13.5% to 6.5% and it has been almost constant since then. In 1987, cephalopelvic disproportion and fetal distress were responsible for nearly 65% of cesarean section rates; this has dropped to about 30% in 1990. This is due to the change in the approach to management of the two conditions. The reduction in cesarean section rates in the four year period was associated with a drop in the perinatal mortality rate, so our experience shows that cesarean section rates can be reduced without increasing the perinatal mortality rate