A descriptive study: maternal and fetal outcome of grand multipara

Sunder Pal Singh, Jyoti Chawan, Divya Mangla

Abstract


Background: Pregnancies in grand multipara have been considered risky for many decades as there are higher chances of complications during pregnancy, labour and puerperium in these women. This study aims to find out various maternal and fetal complications associated with grand multiparty during pregnancy and labour.

Methods: A descriptive observational study was conducted in the department of obstetrics and gynecology of S.K.H.M Medical College Nalhar, Mewat, from Jan, 2014 till Oct, 2014. It included 100 cases of grand multipara women. All the women who delivered at S.K.H.M and had five or more previous viable pregnancies were included in the study.

Results: In the total 100 cases that were included in the study, the common medical illness found in grand multipara were anemia (92%), hypertension (13%), preeclampsia (9%) eclampsia (4%) and diabetics mellitus (2%). Other complications observed were mal-presentations (18%), intra-uterine deaths (18%), preterm labor (15%), placental abruption (8%), shoulder dystocia (6%), placenta previa (5%), obstructed labour (4%), and ruptured uterus (2%). Caesarian section was required in 28% of the cases. Third stage complications were also high in grand multi para e.g. PPH (14%), retained placenta (5%), uterine inversion (3%) and maternal mortality (4%). In perinatal outcomes the observations were lbw babies (15%), macrosomies (10%), and APGAR score (8-10) in 70% of the babies.

Conclusions: Grand multiparity is still a major obstetric hazard which needs strict supervision and good antenatal care and active intervention at appropriate time. Extreme parity should be treated with extra care especially in populations with high rates of unbooked deliveries. 


Keywords


Grand multiparity, Pregnancy outcome, Rural setting

Full Text:

PDF

References


Hoque M, Hoque E, Kader SB. Pregnancy complications of grand multiparity at a rural setting of South Africa. Iran J Reprod Med. 2008;6(1):25-31.

Aslam M. Grand multiparity. J Med Sci. 1994;10(4):317-21.

Abu Heija AT, Chalabi HE. Great grand multiparity; is it a risk? Int J Gynecol and Obstet. 1997;59(3):213-6.

MacGillivray I. Preeclampsia. In: MacGillivray I, eds. The Hypertensive Disease of Pregnancy. 1st ed. London: WB Saunders; 1983.

Zaidi S. The role of the obstetrician in reducing perinatal mortality. In: Zaidi S, eds. Maternal and Perinatal Health. 2nd ed. Karachi: TWEL Publishers; 1992: 115.

Shamshad B. Age and parity related problems affecting outcome of labour in grand multiparas. Pak J Med Res. 2003;42(4):179-84.

Zaheera S, Robina F, Fehmida N. Maternal outcome in grand multiparas. Ann King Edward Med Coll. 2002;8(3):207-10.

Shehla N, Nasreen RF, Shagufta M. Malpresentation incidence and causes. J Postgrad Med Inst. 2001;15(1):33-8.

Ashraf T. Maternal mortality. A four year review. J Col Phys Sur Pak (JCPSP). 1995;6(3):159-61.

Gardner MJ, Altman DG. Cesarean rates. Gardner MJ, Altman DG, eds. Statistics with Confidence. 4th ed. London: BMJ Books; 2000.

MacGillivray I, Samphier M, Little J. Factors affecting twinning. In: MacGilivray I, Campbell DM, Thompson B, eds. Twinning and Twins. 6th ed. US: John Wiley & Sons: 1998; 67-97.

Holloway S, Brock DJH. Changes in maternal age distribution and their possible impact on the demand for prenatal diagnostic services. Br Med J. 1988;296;978-81.

Ferguson-Smith MA, Yates JRW. Maternal age specific rates for chromosome aberrations and factors influencing them: report of a collaborative European study on 52956 amniocenteses. Prenat Diagn. 1984;4:35-44.

Stein AZ. A woman’s age: childbearing and child rearing. Am J Epidemiol. 1985;121:327-42.

Malik S, Naz F. Grandmultiparity: a continuing obstetric risk. J Surg Pak. 2001;6(2):29-31.

Al-Sibai MH, Rehman MS, Rahman J. Obstetric problems in the grand multipara: a clinical study of 1330 cases. J Obstet Gynecol. 1987;8(2):135-8.

Babinski A, Kerenyi T, Torok O, Grazi V, Lapinski RH, Bertwitz RL. Perinatal outcome in grand and great grand multipara effects of parity on obstetric factos. Am J Obstet Gynecol. 1999;181:669-74.

Cande V, Ananth AJ, Savitz DA, Bowes WA, Luther ER. Effects of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Am J Obstet Gynecol. 1996;88(4):51.

Rozina Shahid, Mamoona Mushtaq. Complications of grand multiparity. Pak J Armed Forces. 2009 Sep;(4):1-5.

Ummi H, Zaibunnisa K, Manzoor A. A review of 66 cases of ruptured uterus in a district general hospital. J Postgrad Med Inst. 2002;16(1):49-54.