From April 1985 to March 1986, 1,252 women were admitted for delivery at the Al Hada Armed Forces Hospital, Taif, Saudi Arabia. Of these, 224 (17.9%) were grand multiparas (GM) defined as mothers of parity ≥6. History, labor and delivery as well as postpartum and neonatal courses were recorded using computerized records for later statistical calculations. The obstetric and perinatal outcome was calculated comparing the GMs to para-1 mothers and para-2–5 patients (P2–5), respectively. The latter group being empirically considered as the ‘ideal’ patient group. On comparing the GM group to that of P2–5, significantly higher frequencies of intercurrent diseases, especially diabetes mellitus and gestational diabetes, were found. Among GMs, transverse lie, primary uterine inertia, fetal heart rate abnormalities, failure to progress and postpartum hemorrhage were encountered significantly more often than in the other groups. The incidence of placenta previa was likewise significantly increased among the GMs as was the number of cesarean sections, particularly those of the primary emergency type. There was no maternal mortality. The perinatal morbidity was significantly higher in the GM group. However, no significant difference in perinatal mortality was found between the groups. It is concluded that with few exceptions the GM can be safely delivered by means of modern obstetric management.

12 patients with mild or moderate symptoms of Gardnerella-associated vaginitis were examined clinically and microbiologically on 52 different occasions, 27 of which were asymptomatic. The symptomatic state was defined by fulfilling at least three of the following criteria: (1) subjective symptoms; (2) pH above 4.5; (3) positive amine test, and (4) clue cells in wet smear. Variation of the vaginal microflora was considerable. No causative bacterial species could be identified. Microorganisms of the genus Bacteroides were significantly (p < 0.02) more often found in the symptomatic condition. The presence of either peptococci, peptostreptococci or anaerobic streptococci was similarly related to symptoms (p < 0.01). Lactobacilli were significantly more often present when the patient was free of symptoms (p < 0.05). Gardnerella vaginalis was a common isolate whether the patient suffered from symptoms or not. It is concluded that the presence of this microorganism indicates a disturbed ecologic situation within the vagina, resulting in loss of predominance of lactobacilli and hence liability to develop symptoms.

From 30 consecutive cases of premature rupture of the membranes (PROM) and matched controls, specimens from urine, cervix, amniotic fluid, and placenta as well as neonatal nose and throat swabs were investigated bacteriologically and virologically. In addition virus serological investigation was done. Among the PROM cases the anaerobic cervical isolates outnumbered the aerobic ones, and the total number of aerobic as well as anaerobic isolates was less in the control group. The anaerobes B. fragilis and Strept. intermedius were isolated from the cervix, amniotic fluid, or placenta in 23% and 30% of the PROM patients, respectively. None of the controls harboured B. fragilis, while Strept. intermedius was isolated from 6.7% of the controls. Group B streptococci were recovered from the mother's cervix in 20% of the PROM patients and in 6.7% among the controls. Four cases of neonatal septicaemia were encountered, and another two cases were clinically suspected, but not microbiologically verified, contributing to a high perinatal mortality rate (17,6%). Of the PROM patients, 27% developed puerperal infection, while none of the control mothers had such complications. The significance of the anaerobic bacteria as well as group B streptococci for the maternal and neonatal outcome in cases of PROM is discussed, and a possible aetiological role of ascending infection in this complication of pregnancy is postulated.

The association of premature rupture of the membranes (PROM) and ascending infection was investigated in 15 women. Bacteriological, histological and immunofluorescence methods were used to study infection at various levels in the birth canal. In most of the women the membranes as well as the placentae showed heavy bacterial invasion. Bacterial distribution within the membranes showed a choriodecidual preponderance. Ascending infection appears to follow the choriodecidual route and may be a primary pathogenetic event in many instances of PROM. The anaerobe Bacteroides fragilis, which is very infrequently isolated in normal pregnant women, was found in five out of 15 women. Two infants had congenital pneumonia caused by group B streptococci and Huemophilus influenrue respectively. The neonatal outcome with PROM may be influenced by the efficiency of the individual defence mechanisms including the antimicrobial capacity of amniotic fluid.