Am J Perinatol 2006; 23(6): 345-350
DOI: 10.1055/s-2006-947158
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Grandmultiparas in Modern Obstetrics

Anwar H. Nassar1 , Rania Fayyumy1 , Wael Saab1 , Ghassan Mehio1 , Ihab M. Usta1
  • 1Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
Further Information

Publication History

Publication Date:
13 July 2006 (online)

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.

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

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