Socio-Demographic Profile of Booked Elderly Nulliparous Pregnant Women and Pregnancy Outcome At The University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria

Background: Cultural dictates expect the females to marry early, in most cases and in some communities as virgins, for them to maintain matrimony respect from the husband’s family. Most women delay their pregnancies or become pregnant at advanced ages and are confronted with some challenges associated with pregnancies at the extremes of life. Pregnant women are generally encouraged to book early for antenatal care so that those with underlying medical conditions can be detected early and managed appropriately to prevent adverse effect on the pregnancy and also to reduce possible morbidity and mortality. Fertility tends to decrease with increasing maternal age, so may the pregnancy outcome be complicated. Objectives: This study intends to find out the obstetric characteristics and mode of delivery and delivery outcome of elderly nulliparous or elderly primigravidae who booked at this centre for antenatal care. It also intends to find out the obstetric characteristics of such patients by assessing their age at booking, the mean gestational age at booking, the reasons for delayed pregnancy and delivery and fetal outcome. Methodology: This was a prospective study carried out on pregnant women carrying their first pregnancy to the point of booking for ante natal care at or more than 35 years of age. It was a self administered structured questionnaire and directly administered at booking and followed till delivery over a 1 year period. This prospective study was carried out at the University of Calabar teaching Hospital from June 2017 to June 2018. Those carrying multiple pregnancies were excluded from the final analysis to remove biases, since pregnancy changes are exacerbated in multiple pregnancies. Results: A total of 3,298 pregnant women booked for antenatal care (ANC) during the study period. Of this figure, 218 (6.6%) were elderly primigravidae and elderly nulliparous, while 3,080 (93.4%) were Para 1 and above or below 35years of age. 132 (4.0%) were elderly nulliparous women while 86 (2.6%) were elderly primigravidae. The mean age at booking was 36.3 years. The earliest gestational age at booking was 8-12weeks and did constitute 88(39.8%). Of the 218 cases studied, 30 (13.8%) had spontaneous vaginal delivery. Instrumental delivery (forceps and vacuum) constituted 11.1%. Majority of delivery was 142(65.2%) by caesarean section, either elective or emergencies. The most common medical Abeshi Sylvester E, Department of Obstetrics and Gynaecology, University of Calabar, Nigeria Odusolu Patience O, Department of Obstetrics and Gynaecology, University of Calabar, Nigeria Okon Asuquo O, Department of Obstetrics and Gynaecology, University of Calabar, Nigeria Archibong Eric I, Department of Obstetrics and Gynaecology, University of Calabar, Nigeria complication associated in elderly gravida was hypertensive disorders of pregnancy 21.8%, with cervical incompetence being the least 12 (5.5%) of 218 and was noticed more among the elderly nulliparous. The fetal outcome is comparable to that of the normal population. 259 (83.0%) of the babies were delivered with good Apgar scores and needed no further intervention.