Factors associated with first pregnancy in women who gave birth in a maternity hospital in antananarivo: A retrospective cohort study

Introduction: There are very few African and Malagasy literatures on general risk factors among primigravidae. This study aimed to determine the potential risk factors associated with a first pregnancy. Methods: We conducted a retrospective cohort study among primigravidae and multigravidae women at the Hospital Sainte Fleur Pavilion between October 2014 and December 2016. The relative risks were adjusted after examinations according to sociodemographic features. Results: Primigravidae were far more likely to experience prolonged labour lasting more than 12h (aRR = 2.28; 95% CI 1.74-3.00), emergency cesarean section (RR = 1.47; 95% CI 1.35-1.60) and episiotomy (aRR = 2.98; 95% CI 2.61-3.40). Children were more likely to show signs of fetal distress associated with fetal rhythm abnormalities during labor (aRR = 1.96; 95% CI 1.45-2.65) and an increased risk for intensive care unit admission after birth (aRR = 2.08; 95% CI 1.25-3.45). Conclusion: Complications arising during labor may expose primigravidae to cascading risks concerning delivery outcomes and children's health. The management of labour in primigravidae should require close attention from medical staff.