Browsing by Author "Fakeye, Olurotimi"
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Item Grandmultiparity: Evaluating obstetric and neonatal outcomes after eliminating confounders(National Postgraduate Medical College of Nigeria, 2014-03) Adeniran, Abiodun; Fawole, Adegboyega; Fakeye, Olurotimi; Ijaiya, Munirdeen; Adesina, KikelomoAims and Objectives: The objective was to evaluate obstetric and neonatal outcomes in booked grandmultiparas (para e”5) and compare with outcome in age and social status matched booked multiparas (para 2-4) after eliminating confounders. Patients and Methods: A cohort study with grandmultiparas (subjects) and age and social status matched multiparas as controls. All participants were counseled and an informed consent obtained at the antenatal clinic. Maternal demography and history were taken; they were subsequently monitored during pregnancy, labour and immediate puerperium. The main outcome measures were obstetric and neonatal outcomes among subjects and controls. Results: The incidence of grandmultiparity was 4.1%. During antenatal period, grandmultiparas had statistically significantly higher occurrence of late antenatal booking (P=0.0202), anaemia (P=0.0024) and past history of poor perinatal outcome (P=0.0124). Grandmultiparas had statistically significant occurrence of preterm delivery (P=0.0389) and higher but not statistically significant mean duration of labour (P=0.3532), intrapartum complications (P=0.2014) and postpartum haemorrhage (P=0.2126). Neonates of grandmultiparas had statistically significant low first minute Apgar scores (P=0.0011) with higher but not statistically significant occurrence of low birth weight (P=0.1613) and neonatal intensive care admission (P=0.7202). The perinatal mortality rates were 136 and 75 per 1 000 deliveries for grandmultiparas and multiparas. There were no maternal deaths during the study period. Conclusion: After controlling for age and social class, booked grandmultiparas had poorer obstetric and neonatal outcome compared to booked multiparas but these were majorly statistically insignificant due to effect of modern antenatal care.Item Grandmultiparity: Reasonfor index pregnancy, contraception and relationship to the Millenium Development Goals(School of Medicine, Kenyatta University, Kenya, 2014) Adeniran, Abiodun; Fawole, Adegboyega; Fakeye, OlurotimiObjective: To evaluate the reasons for index pregnancy and contraceptive use among grandmultiparas and relate these to the Millennium Development Goals (MDG).Design: A matched case control study. Setting: The antenatal clinic of the Department of Obstetrics andGynaecology of the University of IlorinTeaching Hospital, Ilorin, Nigeria. Subjects/ participants: Subjects weregrandmultiparas (para ≥5) who presented for antenatal care at the antenatal clinicof the hospital while controls were equal number of age, educational level and social status matched multipara (para 2-4) at the antenatal clinic from 1st January to 31st June, 2010 selected by purposive sampling. Main outcome measures: Level of education, social status, awareness and use of contraceptives, reasons forindex pregnancy and the relationship of these characteristics to the Millennium Development Goals. The data was analyzed using EPI-INFO 6 statistical package with p-value, odds ratio and confidence interval. Results: There were 66 grandmultiparas during the study period; 30% had no formal education while 66.7% were of low social status with 30.3% in social class IV and 36.4% in class V. Contraceptive awareness and use were similar in grandmultiparas and controls; awareness was [90.9% vs. 93.9%, OR=0.65, CI= 0.17-2.4, P 0.7422] while use was 6.4% vs. 40.9%, OR= 0.83, CI= 0.41-1.66, P=0.7207. In both groups, the commonest contraceptive method was Depo-provera [16.7% vs. 15.1%, OR=1.12, CI=0.44-2.85, P 0.8120] while barrier method was the least used [3.0% vs. 6.1%, OR=0.48, CI=0.09-2.74, P=0.6761]. The mother’s reasons for index pregnancy were desire for more children in 33.3%, previous perinatal death in 28.8% and desire for a specific gender in 19.7% of grandmultiparas. Conclusions: Majority of grandmultiparas were poor, uneducated with desire for large families, poor contraceptive users and suffered previous poor perinatal outcome. This is an indicator of a huge gap to fill in attaining the Millennium Development Goal-5 to improve maternal health by reducing maternal mortality by three quarters by 2015.