Far Eastern University

Far Eastern University
Nicanor Reyes St., Sampaloc, Manila

INSTITUTE OF NURSING
Evidenced-Based Nursing
I. Clinical Question
The aim of this study was to compare perinatal outcomes in grand
multiparous and low grand multipara of women in Hawassa University
Comprehensive Specialized Hospital and Adare General Hospital of
Ethiopia.
II. Citation:
A. Title: Inadequate Prenatal Visit and Home Delivery as Determinants of
Perinatal Outcomes: Does Parity Matter?
B. Authors: Nigus Bililign Yimer, 1 Zelalem Tenaw, 2 Kalkidan Solomon, 3
and Tesfahun Mulatu, 4
III. Study Characteristics

A. Patients included
471 mothers (157 grandmultiparas and 314 low multipara) from
February to june 2018.
B. Intervention
The article used a comparative cross-sectional study design. Data were
gathered by giving the patients structured questionnaire. According to the
article, the findings underscores the fact that frequency of antenatal care and
place of delivery are significant predictors of perinatal outcomes. However,
parity did not show a statistically significant difference in perinatal outcomes.
Women empowerment, promoting health facility delivery, and early,
comprehensive antenatal care are needed.
C. Outcome
The study that was conducted brings out the fact that the antenatal care
frequency and the place where they were delivered was the determinants of
perinatal outcomes.
D. Does the study focus on the significant problem in clinical experience?

Yes. In the Philippines, there have been a lot of cases where in mothers are
under the case of grand multiparity even though poverty is rampant.
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IV. Methodology
A. Methodology
Comparative cross-sectional study was conducted from February 1 to
June 30, 2018, in Hawassa University Teaching Hospital and Adare General
Hospital. In obstetrics and gynecology unit of Hawassa University Teaching
Hospital, there are 9 obstetricians and gynecologists and 54 midwives.
Similarly, one obstetrician and gynecologist, four Integrated Emergency
Surgery and Obstetrics (IESO) professionals, 15 midwives, three nurses, and
two public health officers attend obstetric ward of Adare General Hospital. All
multiparous mothers who gave birth in the study areas during the study period
were the source population of this study. Study subjects were identified during
time of admission to labor ward. When eligible mothers were identified after
delivery, admission and registration books as well as patient charts were
checked for pre partum conditions. The total average number of deliveries was
estimated to be 762 per month in the two study hospitals. Sample size was
allocated proportionally to study sites based on their monthly flow of clients
for delivery. The main outcome/dependent variable was adverse perinatal
outcome.
Independent/exposure variables were socio demographic variables
(age, parity, income, education level, etc.) and antenatal profile and obstetric
characteristics (gestational age at first booking, hypertension, diabetes
mellitus, previous history of preterm delivery, intrauterine fetal death, previous
caesarean scar, number of prenatal visits, previous home delivery, etc.). Data
were collected by six trained diploma-holder midwives in the two study sites.
One Bachelor of Science holder midwife was recruited as supervisor at each
study area. The investigator trained data collectors and supervisors for three
days about the tool and data collection procedures. The data were collected by
face-to-face interview and review of clinical documents. For mothers who had
normal delivery, data were collected 1-2 hours after delivery. Mothers who had
caesarean or complicated vaginal delivery waited until they fully awake to
respond the questions.
B. Design
The design used was a comparative cross-sectional study.
C. Setting
Hawassa University Comprehensive Specialized Hospital and Adare
General Hospital of Ethiopia
D. Data Sources
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Bililign Yimer, N., Tenaw, Z., Solomon, K., & Mulatu, T. (2019).
Inadequate Prenatal Visit and Home Delivery as Determinants of Perinatal
Outcomes: Does Parity Matter? Journal of Pregnancy, 1–9.
https://doi.org/10.1155/2019/9024258
http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?
vid=1&sid=c984aa17-441f-44d5-8f46-b2f02322bf86%40pdc-v-sessmgr05
E. Subject selection
All multiparous mothers who gave birth in the study areas during the
study period were the source population of this study. All multiparous,
laboring mothers were the study population. All multiparas with a single
fetus/neonate at a gestational age of ≥28 weeks were included in the study.
Multiparas who were not able to communicate or seriously ill mothers were
excluded from the study.
F. Has the original study replicated

The study has not been replicated up to this day.
G. Results of the study

The mean birth weight (±SD) of newborns was 2994.80 (±601.87) and
3214.98 (±564.60) grams for grand multiparas and low multiparas,
respectively. In the grand multiparous women, more than one-third (34.39%)
participants had adverse perinatal outcomes than 60 (20.07%) in the low
multiparous counterparts (chi2 p=0.001). Adverse perinatal outcomes were
common in women having less four prenatal visits than mothers who had 4
times or more visits (39.23% vs. 20.65%). Additionally, 46 (36.22%)
respondents who had home delivery prior to the current one develop perinatal
complications than only 20.66% of mothers who gave birth at health
institutions (chi2 p=0.001). The prevalence of adverse perinatal outcome was
24.9% (95% CI: 21.1%, 29.1%). Stillbirth (38.9%), low Apgar score (51.9%),
and congenital malformation (3.7%) were frequently occurred complications
in grand multiparas than in low multiparous women.
V. Author’s Conclusion and Recommendations

A. What contribution(s) to the client’s health status do the nursing
action/intervention make?
This finding shows that the place of delivery and frequency of antenatal
care are significant predictors of perinatal outcomes. However, parity did not
show statistically significant difference in perinatal outcomes. Women
empowerment, promoting health facility delivery, and early, comprehensive
antenatal care are needed.
B. Is it feasible to carry out the nursing action in the real world?
367
It is feasible to carry out the nursing action in the real world.
VII. Reviewer’s Conclusion/Commentary

Ninety-nine percent of neonatal deaths occurred in low- and middle-
income countries, mainly from preventable causes. Worldwide, infant deaths are
attributed to multiple economic, maternal, psychosocial, and health behavior
factors. Grand multiparity (≥5 live births/stillbirths) was also associated with low
Apgar score. Similarly, adverse outcomes were seen among high parity women.
Multiple deprivation and poor psychosocial support were determinants of late
prenatal presentation and adverse fetal outcomes. A study in low-resource settings
revealed that women with less antenatal care and delivered without skilled birth
attendant were more likely to have a stillbirth.
VIII. Evaluating Nursing Care Practice

A. Safety
The safety of the respondents were highly considered in this study. As said
from above, the multipara mothers who were not able to communicate seriously
or who are terminally ill were excluded for the study. For mothers who had
normal delivery, data were collected 1-2 hours after delivery. Mothers who had
caesarean or complicated vaginal delivery waited until they fully awake to
respond the questions.
B. Competence of the care provider

Data were collected by six trained diploma-holder midwives in the two
study sites. One Bachelor of Science holder midwife was recruited as supervisor
at each study area. The investigator trained data collectors and supervisors for
three days about the tool and data collection procedures. The data were collected
by face-to-face interview and review of clinical documents.
C. Acceptability
The standard questionnaire has three sections. The first section was
demographic characteristics of the study subjects like age and parity. The second
section was obstetric characteristics of respondents such as hypertension and
diabetes in current pregnancy, previous history of stillbirth and preterm delivery.
The final section of the tool consisted of perinatal outcomes (macrosomia, low
birth weight, congenital malformations, low Apgar score, etc.).
D. Effectiveness
The results of the data were significant to the study because they were able
to identify the risks on the cases of mother with multipara.
E. Efficiency
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The researchers of this study were able to gather all the information they
needed in order to achieve their goal, and to achieve a meaningful study as well.
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Far Eastern University

Nicanor Reyes St., Sampaloc, Manila

III. Study Characteristics

D. Does the study focus on the significant problem in clinical experience?

F. Has the original study replicated

G. Results of the study

V. Author’s Conclusion and Recommendations

B. Is it feasible to carry out the nursing action in the real world?

VII. Reviewer’s Conclusion/Commentary

VIII. Evaluating Nursing Care Practice

B. Competence of the care provider

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