PRETERM LABOUR IN PATIENTS WITH INTERPREGNANCY INTERVAL LESS THAN 6 MONTHS.

Abstract

Background; The time interval between pregnancies is considered to be an important and modifiable risk factor in terms of adverse perinatal outcomes. Traditionally women with a short inter-pregnancy interval will not have sufficient time to recover and get ready for the subsequent pregnancy. This includes socio-economic, cultural, psychological and physical body preparedness. This study was conducted to document the frequency of preterm labor in women having short interpregnancy interval, as there is no such study done in Pakistan on this topic. Objective: To determine the frequency of preterm labour in patients with interpregnancy interval less than 6 months. Material and methods; Patients were selected from OPD of department of Obstetrics and Gynecology, Nishtar hospital Multan, according to inclusion and exclusion criteria of this study. Detailed history was taken regarding demographic distribution, parity, BMI  and duration of pregnancy. Duration of gestation was calculated form patient’s last menstrual period (LMP). Examination was done including general physical examination such as per abdominal examination (SFH, uterine contractions and engagement of head) and per vaginal examination (cervical dilation & effacement and leaking per vaginum). Patients were followed till delivery for outcome variable i.e. preterm birth. Data was transferred and analyzed by SPSS version 20. Results; Mean age of our study cases was noted to be 28.00 ± 4.82 years (with minimum age of our study cases was 20 years while maximum age was noted to be 39 years). Our study results have indicated that majority of our study cases i.e. 151 (67.7 %) were aged 20 – 30 years of age. Of these 90 study cases, 125 (56.1%) were from rural areas, 179 (80.3 %) were normal weight 27(12.1%) were overweight and 17 (7.6 %) were obese. One hundred ninety two (86.1 %) were illiterate. Of these 223 study cases, 178 (79.8 %) were having poor socioeconomic status and 45 (20.2%) were having middle income status, 27 (12.1%) were taking steroid therapy. Of these 223, 36(16.1%), 72 (32.3%) were Saraiki, 27 (12.1%) were Urdu speaking, 62 (27.8%) were baloch, 18 (8.1%) were pathan and 8 (3.6%) were having Sindhi ethnicity. Mean body mass index (BMI) of our study cases was noted to be 21.98 ± 2.21 Kg/m² (with minimum BMI was 18.9 kg/m² while maximum BMI was 32.1 kg/m²). Mean interpregnancy interval was 4.52 ± 1.03 months (with minimum interpregnancy interval was 2 months while maximum interpregnancy interval was 6 months). Mean gestational age of our study cases was noted to be 36.19 ± 3.68 weeks (with minimum gestational age was 28 weeks while maximum gestational age was 40 weeks). Preterm labor was noted in 63 (28.3 %) our study cases and 170 (76.2%%) of our study cases were having parity more than 3. Conclusion; Short interpregnancy interval less than 6 months leads to adverse pregnancy outcomes. Very high frequency of preterm labor was noted in our study cases having interpregnancy interval less than 6 months. Short interprgnancy interval was common in poor, uneducated and rural  ladies. Preterm labor was significantly associated with age, residential status, obesity, ethnicity, steroid therapy and parity. Birth spacing is an issue which women should have some control over. Educational interventions, including birth control, should be applied during prenatal visits and following delivery.

Keywords; Short interpregnancy Interval, gestational age, preterm labor.