Beta-thalassemia which is one of the most common genetic disorders in Bangladesh encompasses a group of monogemic diseases that have reduced synthesis or no synthesis of one or more globin chain of haemoglobin. The defects involved are extremely heterogenous and give rise to a large phenotypic spectrum with patients that are almost asymptomatic to cases in which regular blood transfusions are required to sustain life. The aim of the study is to estimate the frequency of beta thalassemia among the blood recipients in the Day Care Centre of Transfusion Medicine Department of Mymensingh Medical College Hospital from July, 2009 to June, 2010 along with their chelation habit. Retrospective cross-sectional study with the sample size of 784, clinical and family data was collected and descriptive statistics were done in the Laboratory of Transfusion Medicine Department. Among the 784 subjects, the beta thalassemia was 521 (66.46%), among the thalassemic patients only 59(11.32%) take injection Dysferrioxamine (Dysferol), the iron chelating agent. Male are predominant than female (63.53%). Those of the affected patients 67.18% were in age group 6 to 20 years. Although beta thalassemia is one of the first monogemic diseases and represents a global health problem, only recently has the scientific community started to focus on the real molecular mechanisms that underline this disease, opening new & exciting therapeutic perspectives for thalassemic patients worldwide. It is concluded from our study that availability of blood transfusion facilities along with an orally and cheaper iron chelator is an urgent need to ensure the management of needy thalassemic patients in Bangladesh.

There is high incidence of rheumatic valvular heart disease in developing countries like Bangladesh, for which large number of young females undergo valve replacement with mechanical prosthetic heart valve. Pregnancy with mechanical heart valve carries risk of warfarin embryopathy and increased incidence of maternal thrombo-embolism. We had successful outcome of pregnancy of a patient with mechanical prosthetic heart valve with home heparin therapy.

This observational study was done in Colposcopy clinic of Mymensingh Medical College Hospital, to evaluate the accuracy of colposcopic assessment of pre-invasive and early cervical carcinoma comparing with the reference standard of histology, in order to evaluate the justification of colposcopic examination. This study included 227 VIA (visual inspection of cervix with application of 5% acetic acid) test positive patients, who were referred to us for colposcopic evaluation during a period of January 2011 to June 2011. Patient with clinically evident of invasive cervical carcinoma were excluded from this study. VIA test was performed again in all patients prior to systematic colposcopic examination and it was found that 72.6% patients had abnormal colposcopic findings (p<0.05). Directed punch biopsy specimen was taken only from abnormal colposcopic appearances and then it was send for histopathological examination. Records of all available biopsy results were recorded. Correlation of colposcopic impression with colposcopy guided biopsy results was compared. Among 79 colposcopically diagnosed Low-grade Squamous Intraepithelial Lesions (LSIL) or low-grade Cervical Intraepithelial Neoplasia (CIN I) cases, 22.8% cases were chronic cervicities, 69.6% were LSIL (CIN I) and 7.6% were High-grade Squamous Intraepithelial Lesions (HSIL) and among 38 HSIL(CIN II/CIN III) cases, 7.8% were found to chronic cervicities, 31.6% were LSIL and 60.5% were HSIL. Fifteen cases of colposcopically diagnosed preclinical invasive carcinoma were confirmed by histopathology (p<0.05). The rate of false positive is higher in the diagnosis of HSIL than LSIL (39 vs. 30%); on the other hand the rate of false negative was higher in LSIL (9 vs. 4.5%). The sensitivity of colposcopic diagnosis of pre-invasive cervical carcinoma was ranging from 79-82% and specificity ranged between 73-87%. Positive predictive value was 62% for HSIL and 70% for LSIL and the colposcopic accuracy was 91% and 95% for the diagnosis of LSIL and HSIL respectively. All the statistical results were 100% for the diagnosis of preclinical invasive carcinoma. This study showed that colposcopy is a valid tool for the detection of pre-invasive and early cervical carcinoma. It can be considered as a secondary testing tool for VIA positive women.

It was a prospective comparative clinical study carried out in the Department of Anaesthesia, Combined Military Hospital (CMH), Dhaka, to evaluate the heart rate changes during reversal of neuromuscular blockade by using 3 different doses of atropine (in a mixture with neostigmine) and thereby detect comparatively safer dose. Sixty patients of ASA (American Society of Anesthesiologists) grade I and II physical status were divided equally into 3 groups. Neostigmine 0.05 mg/kg body weight mixed with atropine 0.02, 0.015 and 0.01 mg/kg body weight given intravenously in group A, B and C respectively during reversal. The 3 groups were compared in age, sex, body weight, and ASA grades, but there was no significant difference (p>0.05) between 3 groups. It is revealed that in Group C (atropine at a dose of 0.01 mg/kg with neostigmine), heart rate affected very little but salivary and tracheobronchial secretions were more. One of them had laryngospasm which was managed conservatively. In Group B (who received atropine 0.015 mg/kg) incidence of tachycardia observed was less than Group A (who received atropine 0.02 mg/kg). The patients of this group also had some salivary secretions but less than group C. Tachycardia was most marked in Group A but had minimum salivary secretions. Statistical analysis of heart rate changes in different times among the 3 Groups was significant (p<0.05). It was highly significant (p<0.01) in 1 minute after reversal. So relatively lower dose (0.015 mg/kg) of atropine with neostigmine than the conventional dose (0.02mg/kg) can be used to decrease tachycardia during reversal of neuromuscular blockade especially in haemodynamically unstable patients.

The study was done to determine the drug resistance pattern of Methicillin resistant Staphylococcus epidermidis (MRSE) isolated from different clinical specimens at Mymensingh Medical College Hospital, Mymensingh during the period from July 2007 to June 2008. A total of 32 Staphylococcus epidermidis were isolated from 200 different clinical specimens by standard microbiological techniques. Antimicrobial susceptibility of all the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute 2007. Out of 32 Staphylococcus epidermidis 18(56.25%) were detected as Methicillin resistant Staphylococcus epidermidis (MRSE) by disk diffusion method. In this study, Methicillin resistant Staphylococcus epidermidis showed multidrug resistance. Resistant to penicillin, amoxycillin, oxacillin and cloxacillin was 100% followed by gentamycin (56%), erythromycin (50%), doxycycline (44%), cephradine (44%), ciprofloxacin (39%), fucidic acid (33%), cefuroxime (33%) and ceftriaxone (28%). All isolates of MRSE were susceptible to rifampicin and vancomycin.

Swine flu is an important zoonotic disease that has been recognized as an important global health problem by any one of several types of swine influenza virus or swine-origin influenza virus. Due to its increasing incidence in many countries of the world and occurrence of several large outbreaks in present year, it is a burning issue nowadays. It is thought to be a mutation--more specifically, a reassortment of four known strains of influenza A virus subtype H1N1. Swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is not common and does not always lead to human influenza, often resulting only in the production of antibodies in the blood. Due to variability of clinical features and limited availability of laboratory facilities, the disease remains largely under-reported. Early and specific diagnosis is important to ensure a favourable outcome. In this paper we attempted to explore history, classification, transmission, sign symptoms, diagnosis and prevention of swine flu as a critical review to provide some new upgrade regarding this devastating pandemic disease.

The present study was done to evaluate the antibiotic susceptibility pattern of Staphylococcus epidermidis isolated from different clinical specimens and healthy controls in the department of Microbiology, Mymensingh Medical College from July, 2007 to June, 2008. A total of 62 Staphylococcus epidermidis were isolated from 230 specimens. Among them 32(23%) S. epidermidis were isolated from 200 cases and 30(100%) were isolated from 30 healthy controls. Antimicrobial susceptibility test of the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute, 2007. Isolates of S. epidermidis from cases showed multidrug resistance as follows-penicillin 94%, oxacillin 56%, gentamycin 44%, erythromycin 41%, doxycycline 37%, cephradine 34%, ciprofloxacin 28%, ceftriaxone 28%, fusidic acid 22% and cefuroxime 19%. On the other hand, isolates of S. epidermidis from controls were susceptible to all antibiotics except penicillin, which was only 10% resistant. A remarkable difference was observed in the resistance pattern of S. epidermidis isolated from cases and healthy controls. However in our study no isolates of S. epidermidis was resistant to rifampicin and vancomycin, which can be used as last line of drugs to treat nosocomial S. epidermidis infection.

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

Home-based salt-sugar solution (SSS) prepared with labon (locally produced sea salt) and gur (unrefined brown sugar) has been recommended as a cheap, locally available and a simple tool to prevent and treat diarrhoeal dehydration. Preparation of labon-gur SSS is demonstrated to the patients and the attendants at ICDDR, Bangladesh. To evaluate performances, 150 mothers were asked to measure labon and gur by finger pinch and first method and 100 mothers measured half a seer of water to prepare labon-gur SSS, shortly after the demonstration sessions. 4.0% of the samples exceeded the upper safety limit while 1.3% exceeded the upper danger limit for salt and 98.7% samples of gur were within safe and effective range. Mothers' performances were not different with regard to their educational status and prior practice at home. 80% knew about the solution before coming to the hospital and 45% had utilized this knowledge. Our study suggests that demonstration of home-based SSS in a diarrhoeal hospital may positively affect health education and that health personnel should actively participate in increasing health awareness.

Bioreductive drugs are a class of hypoxia selective drugs that are designed to eradicate the hypoxic fraction of solid tumors. Their activity depends upon a number of biological and pharmacological factors and we used a mathematical modeling approach to explore the dynamics of tumor growth, infusion, and penetration of the bioreductive drug Tirapazamine (TPZ). An in-silico model is implemented to calculate the tumor mass considering oxygen and glucose as key microenvironmental parameters. The next stage of the model integrated extra cellular matrix (ECM), cell-cell adhesion, and cell movement parameters as growth constraints. The tumor microenvironments strongly influenced tumor morphology and growth rates. Once the growth model was established, a hybrid model was developed to study drug dynamics inside the hypoxic regions of tumors. The model used 10, 50 and 100 \mu {\rm M} as TPZ initial concentrations and determined TPZ pharmacokinetic (PK)(transport) and pharmacodynamics (cytotoxicity) properties inside hypoxic regions of solid tumor. The model results showed that diminished drug transport is a reason for TPZ failure and recommend the optimization of the drug transport properties in the emerging TPZ generations. The modeling approach used in this study is novel and can be a step to explore the behavioral dynamics of TPZ.

The objectives of this study were to assess the sociodemographic profile and to identify the risk factors of ante-partum fetal death which occurs after the age of viability of fetus. This prospective observational study was conducted in the Obstetrics department of Ad-din Women Medical College Hospital during the period of June, 2009 to July, 2010. A total of 14,015 pregnant patients were admitted in the study place after the age of viability, which was taken as 28 weeks of gestation for our facilities. Eighty-three (0.59%) of them were identified as intrauterine fetal death. Assessment of maternal sociodemographic characteristics and maternal-fetal risk factors were evaluated with a semi structured questionnaire pretested. Majority (81.92%, n=68) of the patients were below 30 years of age, 78.31% belonged to middle socioeconomic group. Almost 58% women had education below SSC level and 28.91% took regular antenatal checkup. About 61.45% patients were multigravida. Most (59.04%) ante-partum deaths were identified below 32 weeks of pregnancy. Out of 83 patients, maternal risk factors were identified in 41(49.59%) cases where fetal risk factors were found in 16(19.27%) cases; no risk factors could be determined in rests. Hypertension (48.78%), diabetes (21.95%), hyperpyrexia (17.3%), abruptio placentae (4.88%) and UTI (7.36%) were identified as maternal factors; and congenital anomaly (37.5%), Rh incompatibility (37.5%), multiple pregnancy (12.5%) and post-maturity (12.5%) were the fetal risk factors. Here, proximal biological risk factors are most important in ante-partum fetal deaths. More investigations and facilities are needed to explain the causes of antepartum deaths.

OBJECTIVE To determine the frequency, types and complications of genital tract trauma during child birth. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Department of Obstetrics and Gynaecology, Unit I, Liaquat University of Medical and Health Sciences, Jamshoro, from June 2006 to May 2010. METHODOLOGY All women who sustained genital tract trauma during delivery at the study centre and those referred from periphery with the same condition within 40 days of delivery were enrolled in the study. Exclusion criteria were women who sustained genital tract injury with caesarean section and genital tract trauma due to accident. Studied variables included age of women, parity, place of labour, type of trauma received and its immediate complications. The data was expressed in terms of descriptive statistics. RESULTS Out of a total 9216 cases admitted in maternity ward during the study period, 467 cases (5.06%) had sustained genital tract trauma. The most frequent obstetrical trauma seen in primiparous referral cases were vaginal tears in 16 cases (25.39%) and perineal tears in 12 cases (19.04%). Multiparous women were 196 (41.97%) and cervical tears were the most frequent obstetrical trauma in them (n=52, 26.53%). Grand multiparous women were 208 having cervical tears (44.4%) and uterine rupture in 77 cases (37.01%) each. Most frequent early morbidities were postpartum haemorrhage (n= 352, 75.37%), hypovolemic shock (n= 220, 47.10%) and infection (n=158, 33.83%). The mortality rate was 16.05%. CONCLUSION Genital tract trauma is a common complication of vaginal birth mostly seen in grand multipara, leading to haemorrhage, shock and infection.

Medical files of women delivered at Kassala Hospital, Eastern Sudan in the period of January-December 2009 were reviewed retrospectively. Out of 4,689 delivered women, 14.7% were teenagers, 67.1% had no antenatal care and 12.6% were grandmultiparous. Obstetric complications included: pre-term birth (2.6%); pre-eclampsia/eclampsia (4.2%); haemorrhage (2.9%); malpresentation (5.5%); obstructed labour (1.9%) and ruptured uterus (0.6%). Caesarean delivery rate was 31.1%. While 89.4% of the newborn babies were taken home, 6% were admitted to the nursery, 4.4% were stillbirths, and 0.2% immediate neonatal deaths. There were 26 maternal deaths (550 per 100,000 live births), mainly due to septicaemia (38.4%), haemorrhage (19.2%), embolism (15.3%) and malaria (11.5%). Thus, there is a high frequency of maternal morbidities and mortality which needs improvement in obstetric care. It is important to make visits from a tertiary hospital to the region to collect statistics and discuss management of the problems they reveal, with the local staff.

OBJECTIVE Estimates of the increased risk of maternal complications after caesarean section posed by placenta praevia differ between studies and may not reflect current practice. We assess the impact of placenta praevia on maternal complications after elective caesarean section (CS). STUDY DESIGN We undertook a retrospective cohort study of women who had an elective CS for a singleton at term in the English National Health Service between 1 April 2000 and 28 February 2009 using routine data from the Hospital Episode Statistics database. Multiple logistic regression was used to estimate the effect of placenta praevia on maternal complications after controlling for maternal age, parity, whether a woman had a previous CS, and gestational age. Maternal complications included postpartum haemorrhage, obstetric trauma, blood transfusion and hysterectomy. RESULTS Among 131,731 women having an elective CS for a singleton, 4,332 (3.3%) women had placenta praevia. Placenta praevia increased the risk of postpartum haemorrhage from 9.7% to 17.5%(adjusted odds ratio (OR) 1.91; 95% CI: 1.74 to 2.09), the risk of blood transfusion from 1.4% to 6.4%(OR 4.39; 3.76 to 5.12), and the risk of hysterectomy from 0.03% to 1%(OR 39.70; 22.42 to 70.30). Previous studies have estimated the rate of hysterectomy among women with placenta praevia to be 5%. CONCLUSION Placenta praevia remains a risk factor for various maternal complications, although the increased risk of hysterectomy is lower than previously reported.

Grand multiparity has been described as an independent risk factor for a variety of obstetric complications, especially in developing countries with inadequate health facilities. This case control study compares the pregnancy outcomes of grand multiparas with that of multiparas at the University of Maiduguri Teaching Hospital over a period of 1 year. The labour ward records and patients' case notes were used to extract information. Multivariate analysis created a model of the adverse factors that were independently associated with grand multiparity after control for confounding effects of age and other variables. During the period of study, there were 1,865 deliveries, out of which 350 were grandmultiparas, a rate of 18.8%. Out of the 350 grandmultiparas, 91 were excluded, leaving 259 (74%) patients which were used for the study. The multivariate analysis shows that compared with the multiparas, the grand multiparas were more likely to be uneducated, have abruptio placentae, precipitate labour and stillbirth but were less likely to have prolonged labour, episiotomy, placenta praevia, require operative deliveries or be anaemic at booking. Grandmultiparity was found to be associated with adverse pregnancy outcome. This finding has implications for practitioners caring for these women in our environment.

OBJECTIVE The objective was to review the obstetric performance of booked grand multiparae. DESIGN AND SETTING A 5-year prospective observational study of cases between January 1, 2002, and December 31, 2006, was conducted in Aminu Kano Teaching Hospital, a tertiary institution, in Kano, Nigeria. MATERIALS AND METHODS The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery), who delivered in our labor ward, were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. OUTCOME MEASURES These were obstetric factors of maternal age and parity, antepartum hemorrhage, fetal malpresentations, and multiple pregnancy. Medical complications were gestational diabetes, hypertension, anemia, and heart disease. Pregnancy outcomes measured were gestational age at delivery, birth weight, mode of delivery, postpartum hemorrhage, and maternal and perinatal mortality. RESULTS The age range of the grand multiparae was between 22 and 43 years, with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15, with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55, CI = 6.72-23.91), hypertension (OR = 3.07, CI = 2.07-4.59), heart disease (OR = 2.01, CI = 0.70-6.08), anemia (OR = 3.16, CI = 1.42-7.24), antepartum hemorrhage (OR = 2.18, CI = 1.22-3.92), fetal malpresentations (OR = 3.04, CI = 2.38-3.88), cephalopelvic disproportion (OR = 2.09, CI = 1.33-3.29), and fetal macrosomia (OR = 2.27, CI = 1.72-3.00) among the grand multiparae compared with multiparae. Conclusion: The effects of these complications were minimized by good antenatal care.

Malaria during pregnancy is a recognised risk factor for maternal and foetal complications and it is endemic in certain areas of our country. Pregnancy also enhances the severity of malaria particularly with P falciparum infestation. The outcome of effects of malaria in pregnancy on the mother and foetus is studied here. This is a prospective observational study conducted in the department of obstetrics and gynaecology of RG Kar Medical College during the period from 1st January 2001 to 31st December 2006. Forty pregnant women with malaria in pregnancy were studied. Another 40 non- pregnant women during the same period were served as control. The maternal complications were compared with the controls and the outcome of pregnancy was studied. There was statistically significant (p < 0.05) increase in the incidence of anaemia, cerebral malaria, renal failure, hepatic failure, hypoglycaemia, hypotension and death in the pregnant women in comparison to non-pregnant women. P falciparum infection was also more during pregnancy. There was also increased incidence of abqrtion, preterm labour, intra-uterine growth restriction and intra-uterine foetal death. Treatment with antimalarial drugs particularly in cerebral malaria does not give good results as there were 12 maternal deaths in this series. Every attempt should be made to prevent malaria during pregnancy by various measures as it is associated with high maternal morbidity and mortality and adversely affects the neonatal outcome.

To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage (APH). Cross-sectional, analytical study. Gynaecology Unit II, Civil Hospital, Karachi, from August 2007 to July 2009. Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of pregnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing≥500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level<0.05. Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 (p<0.01). Near-miss cases were also significantly higher in abruptio placentae, 22.27% verus 11.18%(p<0.01). Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae (p<0.05). Abruptio placentae carry significantly higher perinatal mortality and near-miss morbidity than placenta previa.

OBJECTIVE To determine the risk factors in pregnancies complicated with abruptio placenta METHODS Case-control study. The study was conducted at department of Obstetrics and Gynecology Unit 3, Civil Hospital, Dow University of Health Sciences Karachi. The study period was from January to December 2008. All pregnant women who were diagnosed with abruptio placenta after 28 weeks of gestation were included in the study. They were compared with women who had live birth during the study period. This group was taken as controls. Both groups were identified from the admission, labour room registers. RESULTS Total number of deliveries during the study period was 2610. Patients identified with abrupio placenta were 81, giving a frequency of 3.75%. Majority (44%) of women were between 26-30 years of age group. Forty three (54%) of the women were second, third or fourth gravida. The mean gestational age was 34 +/- 4.21 weeks. Forty one (51%) delivered preterm before 37 weeks and 40 (49%) delivered at or after 37 completed weeks of gestation. Vaginal delivery was the main mode of delivery, followed by Caesarean section. Vaginal bleeding was the most common clinical finding seen in 80%(68/81) women, followed by blood stained amniotic fluid in 45%(37/81). Foetal heart sounds were absent on admission in 65%(53/81). There were two maternal deaths due to postpartum haemorrhage. The perinatal mortality rate was 66%(54/81). Parity and gestational age were found to be significant risk factors for abruptio placentae (p < 0.031 and p < 0.001 respectively). CONCLUSION Abruptio placenta is associated with poor maternal and foetal outcomes.

OBJECTIVE To investigate pregnancy and labour outcomes in grand and great grand multiparous women. STUDY DESIGN A retrospective population-based study was conducted between the years 1988 and 2007. Parturients were classified into three groups: multiparous; 2-5 deliveries, grand multiparous; 6-9 deliveries, and great grand multiparous; 10+ deliveries. Stratified analyses included multiple logistic regression models. RESULTS A significant linear association was found between parity and adverse maternal and perinatal outcomes such as malpresentation, labour dystocia, caesarean delivery, postpartum haemorrhage, maternal anaemia (HB<10), congenital malformations and perinatal mortality. Using multivariable logistic regression models, grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=1.5, P<0.001), and perinatal mortality (OR=2.0, P<0.001). Great grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=2.6, P<0.001), labour dystocia, second stage (OR=2.1, P<0.001), and perinatal mortality (OR=2.5, P<0.001). CONCLUSION Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is higher for great grand multiparous women compared to grand multiparous women. Grand and great grand multiparity are independent risk factors for labour dystocia and perinatal mortality.