Ann. Pak. Inst. Med. Sci. 2010; 6(1): 58-61

Objective: To compare the obstetric outcome between grandmultiparae and multiparae at a tertiary care center.
Study Design: Cross sectional comparative study.
Place and Duration: This study was done in Gynae/Obs Unit - I, Holy Family Hospital, Rawalpindi over a period of one year, from Jan. 2003 to Dec.2003.
Materials and Methods: A total of 200 pregnant women beyond 28 weeks of gestation were studied. Group I included 100 grandmultiparous women (parity≥5) and group II included equal number of multiparous women(parity <5). At admission a detailed history was taken and previous record was reviewed for any antenatal complications, the study population was followed throughout labor and postnatal period for any complication till discharge from the hospital. The neonates were followed in neonatal intensive care unit (NICU) and early neonatal deaths (ENND) were noted. The data was analyzed using SPSS.
Results: There was no significant difference in antenatal complications between two groups. The most frequent complication seen in both groups was anemia (i.e. 36% vs. 30%). The overall incidence of Intrapartum complications was 32% in grandmultiparae group and 41% in multiparae group showing increased rate in low parity group. Regarding the postpartum complications, the rate of PPH (Postparturm Haemorrhage) was 3% in grandmultiparae group and 4% in multiparae group, indicating no increased risk with increasing parity. The rate of perineal tears was observed to be significantly less in grandmultiparae than multiparae, (9% vs. 20% respectively), showing a statistically significant difference. There was only one maternal death in each group. Neonatal outcome in this study showed slightly increased rate of macrosomia. The incidence of congenital anomalies and perinatal deaths was higher in grandmultiparae group but the difference was not statistically significant.
Conclusion: Grandmultiparity is not an independent risk factor for poor pregnancy outcome. . It carries no significant risk of obstetric and neonatal complications, especially in settings where modern obstetrical care is readily available.
Key words: Grandmultiparae, Parity, Obstetric complications, neonatal complications

Introduction


Grandmultiparity in relation to obstetric performance is labeled high risk. A high risk pregnancy is defined as one in which the mother, fetus or new born will be at increased risk of morbidity or mortality at or after birth. The risk to the mother and child is relatively high in first pregnancy, drops sharply in second, third and then slowly rises with increasing parity by the sixth pregnancy.¹ The term grandmultiparity is the condition of a woman who has had five or more previous viable babies.^2,3 Grandmultiparity is reported to increase both maternal and perinatal morbidity and mortality. It is generally accepted that grandmultiparity is risk factor for obstetric complications.^5,6
The incidence of grandmultiparity has decreased in most western countries in recent years due to better socioeconomic status and high use of contraception. In developing countries like Pakistan, the large family size is still common.⁴ Grandmultiparity is a common problem in this part of the world and when added to low socioeconomic status, it significantly increases the risk to mother and fetus.¹³ More studies are needed to update our experience with grandmultiparity.¹⁴ Keeping in view this background, we conducted a study comparing the obstetric outcome between grandmultiparae and multiparae. This study was done at Gynae/Obs Unit-I Holy Family Hospital, Rawalpindi. It is a well-equipped teaching unit of a tertiary care hospital, located in the main city and majority of the patients presenting in this hospital belong to poor socioeconomic class. We tried to evaluate whether grandmultiparae from low socio-economic class, delivering in a setting of modern obstetric care, are a high risk group for obstetric and neonatal complications.