The “Grand Multipara” - Is it a problem? A review of 5785 cases

Abstract

The Grand Multipara (GM) has almost disappeared in the Western countries due to the advancement of family planning. Having a heterogeneous population, the problem of Grand Multiparity still exists in our country. This study is based on 5785 cases of GM which were treated in our Obstetrical Department during a period of 16 years (1960-1975). We have compared this group to the general obstetrical population in terms of pregnancy and delivery complications. Face and breech presentations as well as transverse lie were twice, brow presentations were three times as frequent in the GM group. Postpartum hemorrhage (P.P.H.) was four times and premature separation of the placenta twice as frequent. Rupture of the uterus was about 20 times more frequent. Forceps delivery and Cesarean section rate were twice, while the vacuum extraction 5-fold more frequent. Though there was no material mortality and perinatal mortality was not higher than in the general population. Even though the percentage of GM in our population has been decreased in the last 10 years, our results suggest that Grand Multiparity is still a high risk obstetrical problem.

Trends in the Occurrence of Antenatal and Perinatal Complications with Increasing Parity

“…While many antenatal and intrapartum complications like diabetes (overt and gestational), anemia, preterm delivery, malpresentation at term, postpartum hemorrhage, macrosomia showed a significant linear increase with increasing parity as indicated by v 2 test for linear trend (Fig. 1) as also reported by many other studies [3][4][5][6][7][8][9]; there were some, like the need for labor augmentation with its attendant risks specially in women of higher parity and soft tissue injuries, which showed a significantly declining trend with increasing parity as indicated by v 2 test for linear trend (Fig. 2).…”

“…Most of the studies in the literature have compared the outcome between women of low parity (parity 2-4) and grand multiparty (parity [5][6][7][8][9], but only few studies have compared the outcome between the three groups as defined by International Federation of Gynecology and Obstetrics: lower parity (parity 2-4), grand multiparity (parity [5][6][7][8][9] and great grand multiparity (parity 10 and above).…”

Grandmultiparae in a modern setting

“…In contrast two other studies from Israel reported an increase in classical complications said to be associated with grandmultiparity 5,6 . This difference may be because neither study used aged matched controls and advanced maternal age has been associated with a higher incidence of chronic hypertension, diabetes, and other antepartum complications which may also influence intrapartum events.…”

Multiparity and Childbirth Complications in Rural Women of Northeastern Nigerian Origi

“…Hence, grandmultiparity has been defined by the International Federation of Gynecology and Obstetrics (1993) as delivery of the fifth to ninth viable pregnancies 1,2,3,4,5 .Multiparity has been identified as an independent risk factor for a varietyof serious intrapartum complications including: placentaprevia, placental abruption, malpresentation ofthe fetus, instrumented delivery, cesarean delivery,postpartum hemorrhage, prematurity, newborn intensivecare unit admission, and maternal death. 4,[6][7][8][9] -Multiparity‖, from the introduction of the term had been regarded -dangerous‖ and an independent factor in maternal and infantile morbidity and mortality 7,[10][11][12][13][14] . Although some other works tried shifting the blame to other factors including: poor perinatal care 2,6,[15][16][17][18][19], interpopulation differences 20 , poor socio-economic status [23][24][25] as well as advanced maternal age [28][29][30][31] .There has been repeatedly mixed results as various researchers have observed inconsistent outcomes in seemingly similar populations.…”