Risk assessment is a crucial aspect of intrapartum and antenatal care. However, the assessment of complicated birth in nulliparous and multiparous women remains controversial. This study aims to ascertain the rate of complicated birth at term in multiparous and nulliparous women.

This cohort study included a total of 276,766 women with a singleton birth at term after a trial of labor. The included women had no pre-existing medical conditions, complications during pregnancy, or important obstetric history. The primary outcome of the study was a composite outcome of a complicated birth, defined as cesarean delivery, postpartum hemorrhage, anal sphincter injury, or birth with the use of an instrument.

The studies suggested that multiparous women had the lowest rates of a complicated birth, with 8.8% in those without any risk factors and 21.8% in those with risk factors. Comparatively, the risk of complicated birth was higher in nulliparous women, with the rates oscillating between 43.4% to 64.3%. In multiparous women, the risk of birth complications was significantly high (42-66%) for those with previous cesarean section.

The research concluded that nulliparous women were at a higher risk of birth complications as compared to multiparous women.

Ref: https://www.bmj.com/content/371/bmj.m3377