Grandmultiparae in a modern setting

Abstract

Objective To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among women who had previously delivered five or more times (grandmultiparous) with that of agematched control women who had previously delivered two or three times (multiparous). Design A matched cohort study.Setting An inner city university maternity hospital in the United Kingdom.Sample Three hundred and ninety-seven grandmultiparous women were compared with three hundred and ninety-seven age-matched multiparous women. Methods Data on the subjects were obtained from a computerised maternity information system (SMMIS).Characteristics and complications occurring in the two groups were compared. Data validation was performed with a 10% randomised sample of the casenotes in both groups. Nineteen relevant data fields were abstracted and compared with the matched SMMIS record. Results The overall incidence of intrapartum complications for grandmultiparous women was 16% compared with 18% in the control multiparous women (odds ratio 0.9, 95% CI 0.6 -1.3). Grand multiparity was associated with a significantly higher body mass index at booking ( P < 0.01) and the last antenatal clinic ( P < 0.05), an increased incidence of antenatal anaemia (22% vs 16%, odds ratio 1.8, 95% CI 1.2 -2.8) and a decreased incidence of elective caesarean section (6% vs 11%, odds ratio 0.5, 95% CI 0.3-0.9). Agreement was greater than 95% in all the data fields reviewed except three. In the 14 categorical variables reviewed the Cohen's kappa results were in excess of 0.6. Conclusion This study suggests that in a developed country with satisfactory health care conditions, grandmultiparity should not be considered dangerous, and risk assessment should be based on past and present history and not simply on the basis of parity.

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).…”

“…Bethel Solomon's concerns as expressed in his article ''The dangerous multipara'' in 1934 were found to be genuine about the risks associated with grand multiparity [7]. The risks definitely exist in women of grand multiparity, but it might be unreasonable to attribute all the risks to parity.…”

“…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).…”

Feto-maternal outcome in grand multipara

“…6 The International Federation of Gynaecology and Obstetrics (1993) define grand multiparity as delivery of the fifth to ninth infant, whereas delivery of the ten (or more) are considered being greatgrandmultiparas. 7 Solomon's pointed out that maternal mortality was higher in grand multipara, which number increased steadily as parity became greater.…”

“…9 However, there is still controversy as some studies reported that grand multiparous women don't have an increased incidence of obstetric complications particularly in developed countries where there is satisfactory health care conditions. 7,11 During the last few decades the proportion of grand multipara has decreased in most developed countries because of a dramatic change in the practice of contraception and the acceptance of family planning methods. 6 In present set, up grand multiparity is associated with increased likelihood of maternal and perinatal complications.…”