Grandmultiparitytrends and complications: a study in two hospital settings

Abstract

Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8.99% (10.90% in 1987 to 3.36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8.59% (12.75% to 6.07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91.6% vs. 94.9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85.8% vs. 69.7%, respectively). In Group B 85.9% had spontaneous vertex delivery as opposed to 66.3% in Group A. Caesarean section was the mode of delivery in 9.0% and 24.2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2.51-3.00 kg in both groups. Macrosomic babies formed 3.7% in Group A and 2.4% in Group B, while low birth weight babies formed 17.7% and 11.7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10.85/100 000 total deliveries in Group A and 35.42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3.4% and 6.1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH b...

Grandmultiparity: Incidence, consequences and outcome in the Niger delta of Nigeria

“…The spontaneous vaginal delivery rate was within the range of 55.35% to 95.2%, which was similar to earlier reports from other centres in Nigeria [1,4,19].…”

“…Majority of the patients delivered at term and the incidence of post term was higher than that reported from South Africa [14]. Macrosomic babies accounted for 16% of birth weights while low birth weight rate was similar to findings in Ibadan [4]. The significant low birth weight could be from high incidence of twin pregnancy, premature rupture of membrane, preterm labour, intrauterine growth restriction which could occur in patients with hypertensive disorders as well as iatrogenic prematurity from delivery of patients with severe preeclampsia.…”

“…Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities because of serious consequences to the fetus, the mother, the family and the society in general [4,5]. This has led to efforts being made by the non-governmental, national and international agencies to reduce fertility rates.…”

Grand multiparity: is it still a risk in pregnancy?

“…Hence, high parity is not considered to be a risk factor for pregnancy-related complications [7-9]. Conversely, a high prevalence of GM has been reported in “developing” countries [10-12]. …”

Outcome of caesarean section at the Edward Francis Small Teaching Hospital, Banjul The Gambia

“…Caesarean section rates increased with increasing parity in our study (p <0.001). A Nigerian study found increased caesarean section rates for grand multiparous women 34 . Women who booked for antenatal care were less likely to have a caesarean section in this study (p = 0.0018).…”