ABSTRACT
The objective of this study was to compare incidence of antenatal and intrapartum
complications among women who had previously delivered five or more times (grandmultiparas
cases, 155) with that of age-matched women with two to three previous deliveries (multiparas
controls, 155) from 1998 to 2003. Grandmultiparity was associated with a low socioeconomic
status, higher incidence of smoking, and a higher body mass index. Grandmultiparas
had ~2-fold increased risk of gestational diabetes, hypertensive disorders, malpresentation,
and preterm delivery, and a 3-fold increased risk of abruption; none reached statistical
significance. No significant differences were found in antepartum hemorrhage, anemia,
postdatism, polyhydramnios, or placenta previa. Intrapartum complications (labor induction,
nonreassuring fetal heart, primary cesarean delivery, and intrapartum fever) were
similar; however, operative vaginal delivery was significantly lower in grandmultiparas
cases. Both groups were similar regarding birthweight, macrosomia, intrauterine growth
restriction, Apgar scores, and stillbirth rates. Our study shows a trend toward an
increased risk of adverse obstetrical outcome in grandmultiparas compared with multiparas
independent of maternal age.
KEYWORDS
Grandmultiparity - intrapartum complications - antepartum complications
REFERENCES
- 1
Bai J, Wong F W, Bauman A, Mohsin M.
Parity and pregnancy outcomes.
Am J Obstet Gynecol.
2002;
186
274-278
- 2
Toohey J S, Keegan Jr K A, Morgan M A, Francis J, Task S, deVeciana M.
The “dangerous multipara”: fact or fiction?.
Am J Obstet Gynecol.
1995;
172
683-686
- 3
Ziel H A.
Grand multiparity-its obstetric complications.
Am J Obstet Gynecol.
1962;
84
1427-1441
- 4
Rizk D E, Khalfan M, Ezimokhai M.
Obstetric outcome in grand multipara in the United Arab Emirates: a case control study.
Arch Gynecol Obstet.
2001;
264
194-198
- 5
Goldman G A, Kaplan B, Neri A, Hecht-Resnick R, Harel L, Ovadia J.
The grand multipara.
Eur J Obstet Gynecol Reprod Biol.
1995;
61
105-109
- 6
Israel S L, Blazar A S.
Obstetric behavior of the grand multipara.
Am J Obstet Gynecol.
1965;
91
326-332
- 7
Nelson J H, Sandmeyer M W.
A study of 812 grand multiparas.
Am J Obstet Gynecol.
1958;
75
1262-1266
- 8
Tanbo T G, Bungum L.
The grand multipara-maternal and neonatal complications.
Acta Obstet Gynecol Scand.
1987;
66
53-56
- 9
Scharfman E, Silverstein L M.
The grand multipara: a survey of 403 cases.
Am J Obstet Gynecol.
1962;
84
1442-1446
- 10
Abu-Heija A T, Chalabi H E.
Great grand multiparity: is it a risk?.
Int J Gynecol Obstet.
1997;
59
213-216
- 11
Eidelman A I, Kamar R, Schimmel M S, Bar-On E.
The grandmultipara: is she still a risk?.
Am J Obstet Gynecol.
1988;
158
389-392
- 12
Roman H, Robillard P Y, Verspyck E, Hulsey T C, Marpeau L, Barau G.
Obstetric and neonatal outcomes in grand multiparity.
Obstet Gynecol.
2004;
103
1294-1299
- 13
Bugg G J, Atwal G S, Maresh M.
Grandmultiparae in a modern setting.
BJOG.
2002;
109
249-253
- 14
Babinszki A, Kerenyi T, Torok O, Grazi V, Lapinski R H, Berkowitz R L.
Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric
risk factors.
Am J Obstet Gynecol.
1999;
181
669-674
- 15
Seoud M A, Nassar A H, Usta I M, Melhem Z, Kazma A, Khalil A M.
Impact of advanced maternal age on pregnancy outcome.
Am J Perinatol.
2002;
19
1-8
- 16 American College of Obstetricians and Gynecologists .Technical Bulletin 30: Gestational
Diabetes. Washington, DC; ACOG 2001
- 17
Brenner W E, Edelman D A, Hendricks C H.
A standard of fetal growth for the United States of America.
Am J Gynecol Obstet.
1976;
126
555-564
- 18
Ozumba B C, Igwegbe A O.
The challenge of grandmultiparity in Nigerian obstetric practice.
Int J Gynaecol Obstet.
1992;
37
259-264
- 19
Rode L, Nilas L, Wojdemann K, Tabor A.
Obesity-related complications in Danish single cephalic term pregnancies.
Obstet Gynecol.
2005;
105
537-542
- 20
Aliyu M H, Jolly P E, Ehiri J E, Salihu H M.
High parity and adverse birth outcomes: exploring the maze.
Birth.
2005;
32(1)
45-59
Ihab M UstaM.D.
Department of Obstetrics and Gynecology, American University of Beirut Medical Center
P.O. Box 113-6044/C53, Beirut, Lebanon
