Analyzing Fetal Outcomes Variability in Women with Short Inter-Pregnancy Intervals: A Cross-Sectional Study

fetal outcomes in

outcomes, emphasizing the potential of birth spacing as an avenue to mitigate health inequities and reduce unfavorable effects [5,6].Short IPI poses risks during pregnancy and extends its implications to subsequent deliveries.Research indicates that females with fewer preceding interpregnancy periods are an independent consequence of highly preterm birth, moderately preterm birth, and death in neonates, irrespective of congenital abnormalities [7].Complications associated with the second birth are further intensi ed when the rst pregnancy has encountered issues, leading to a substantial surplus of intrauterine development restriction, preterm birth, and perinatal deaths in initial births.These ndings u n d e r s c o re t h e i m p o r t a n c e of c o n s i d e r i n g t h e interpregnancy interval and the mother's obstetric history when evaluating outcomes [8,9].Examining the correlation between short IPI and harmful effects in vaginal deliveries after previous cesarean sections reveals an increased threat of uterine damage and other obstacles [10].The risk triples for patients with Vaginal Birth After Cesarean (VBAC) having short IPI, necessitating careful case selection and counselling.The study's primary objective is to identify short IPI as a signi cant risk factor in the Khyber Pakhtunkhwa (KPK) population [11].This region's socioeconomic fragility and limited healthcare resources amplify the potential health risks of short IPI.The research underscores the need for preventive measures, health education during the post-natal period, and improved access to family planning services to enhance the well-being of both mothers and children in socio-economically vulnerable communities [12].This investigation aimed to nd the frequency of different fetal outcomes in women with short inter-pregnancy intervals.ethical review committee.The sample size was calculated to be n=170 by following the World Health Organization sample size calculator with the following assumptions: Con dence inter val = 95%.Predicted population proportion = 4.14% for perinatal death.Absolute precision = 3%.The non-probability consecutive sampling was followed to obtain the data from patients.These parameters are included in the inclusion criteria: All the pregnant women had short inter-pregnancy intervals presenting at 20 weeks of gestation.The age range of patients above 16 years and below 45 years.These parameters are included in the exclusion criteria: Subjects having multiple gestations on the ultrasound.These include preterm labour, premature rupture of membrane, short for gestational age, postpartum haemorrhage, women having any infections during pregnancy or having any metabolic disease, e.g.diabetes, etc.The following procedure was followed for data collection: Noti ed printed consent was used from the selected female who ful lled the selection criteria after permission was sought for this study.Women presenting in the OPD after the 20th week of gestation who tted the criteria (i.e., pregnant women with a singleton pregnancy with short inertpregnancy interval) were taken to a separate place.They elaborated the objectives and bene ts of the research for informed consent.The data collection proforma documented each patient's detailed history and clinical examination regarding gravidity, parity, gestational age, last baby born, and presenting complaints.General physical examination, which included per abdomen assessment and vaginal examination, was performed according to gestational age.The radiology department will carry out obstetric ultrasound for proper fetal growth and weight of the baby.All the women were followed up regularly to detect common maternal outcomes (premature rupture of membranes, C-section).Outcome measures of fetal data were also collected.Fetal data included; (1) Period of gestation as the duration calculated in weeks from the previous menstrual cycle to the date of the child's birth.(2) Perinatal deaths encompass fetal deaths with a presumed gestation period of 28 weeks or more and infant deaths occurring within the rst week of life.(3) Birth weight data included babies weighing less than 2.5 kg, which signi es low birth weight.The gathered data underwent analysis using SPSS version 21.0.Quantitative variables like age, gravidity, parity, gestation period and baby weight were described as mean ± S.D. Frequencies and percentages were calculated for categorical variables like premature rupture of membranes, preterm birth and low birth weight.Common maternal and fetal outcomes were strati ed among age, gravity and parity to see the effect of modi cations.All the data has been presented in

M E T H O D S
I n o b s te t r i c s , t h e te r m s "m u l t i g r a v i d a , " "g r a n d multigravida," and "great grand multigravida" are used to categorize women based on the number of pregnancies they have experienced [9,11].A multigravida refers to a woman who has been pregnant two or more times.Therefore, a multigravida has experienced two or more pregnancies, regardless of the outcome of those pregnancies.A grand multigravida is a female who has had ve or more pregnancies and has a signi cant reproductive history.A great grand multigravida is a female who has had ten or more pregnancies and has undergone the experience of being pregnant ten or more times, representing a substantial reproductive history [13].Cross-sectional research was conducted for almost nine months from September 28, 2020, to June 20 2021, in Department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad.Ethical approval was taken from It is well established that a short inter-pregnancy interval (IPI) is associated with an increased risk of adverse fetal outcomes in subsequent pregnancies [13].This study focused on the population of the Rural Health Center in Kangra, District Haripur, Khyber Pakhtunkhwa, Pakistan, with most patients from average to low-income households.The potential confounding factors of illiteracy and poor socioeconomic conditions in this area need separate investigation.Despite efforts to control factors in uencing low birth weight, preterm delivery, and intrauterine growth restriction (IUGR), it is acknowledged that other factors may have in uenced the ndings [14].The IPI plays a crucial role in newborn health outcomes, considering factors such as preterm premature rupture of membranes, preterm birth, early neonatal death, low birth weight, and small for gestational age (SGA).The study found that a signi cant percentage of sampled females experienced preterm premature rupture of membranes (32%), preterm birth (39%), early neonatal death (12%), and low birth weight (25%).Gravidity distribution indicated that 78% were multigravida, 19% grand multigravida, and 4% great grand multigravida [15,16].Using recent nationally representative Demographic and Health Survey (DHS) data, researchers examined infant mortality in patients under 18 years and over 18 years, considering IPI less than 24 months and greater than 24 months for the rstborn child [17].The study concluded that both young maternal age and short IPI increased the risk of infant mortality in developing

R E S U L T S
The study was conducted at the Gynecology Department, Rural Health Center, Kangra, District Haripur, Khyber Pakhtunkhwa, Pakistan.A total of 170 female patients were included in the study to nd out the fetal outcomes among women with short IPI presenting in their second and third trimesters.A short IPI was de ned as an interval of less than 18 months between the live birth and the subsequent pregnancy.Maternal age among 170 patients was analyzed in frequencies and percentages ( The gravidity status regarding frequencies and percentages was also analyzed (Table 2).The gravidity status was divided into 3 main categories, i.e. multi gravida, grand gravida and great grand multigravida.Among 170 patients, 132 (77.65%) were multigravida, 32 (18.82%) were grand multigravida, and 6 (3.53%) were great grand multigravida.Frequencies and percentages were calculated for the poor fetal outcomes of the studied sample in table 3.Among 170 females, 53 (31.17%) had preterm premature rupture of membranes of the fetus, 63 (37.05%) had neonates with preterm birth, 20 (11.76%) suffered early neonatal death, and 34 (20.21%) had newborns with low birth weight.The frequencies and percentage of fetal outcomes in gravidity n=170 are shown in table 5. We did not nd any normal outcome of IPI in any of the cases in our study.The absence of normal outcomes could be attributed to various factors such as complications, adverse events, or speci c characteristics of the population we studied.So, targeted counselling and therapies for this high-risk group are warranted, considering the signi cant public health and cost burden associated with these cases.Previous research, both in low and high-income countries, indicates that both short and long-term IPIs are associated with adverse maternal, perinatal, and infant outcomes.Short IPI is linked to higher risks of perinatal, infant, and child mortality, as well as preterm birth, low birth weight, and fetal growth restriction, while long IPI is associated with increased risks of preterm birth, low birth weight, labor dystocia, preeclampsia, and eclampsia [22,23].
interpregnancy intervals in obstetrics need to be implemented for all women, the importance of which cannot be further emphasized.
Copyright © 2023.PBMJ, Published by Crosslinks International Publishers PBMJ VOL. 6 Issue.12 December 2023 the form of tables and diagrams.

Table 1 :
Frequencies and percentages of maternal age (n=170)

Table 3 :
Frequencies and percentages of fetal outcomes (n=170)

Table 4 :
Correlation of fetal outcomes in age groups (n=170)

Table 5 :
Frequencies and percentages of fetal outcomes in gravidity (n=170)