The ‘′grand multipara’’–is it a problem? The small number of studies that have controlled for age have yielded conflicting results,1–4,10,14 and no published studies have focused on the unique risks associated with grand multiparity in young women. RESULTS: Great grand multiparous women are older. grand multiparity, contracted pelvis, high maternal age and uterine anomalies including fibroma. In the UK: Gravidityis defined as the number of times that a woman has been pregnant. Grand Multiparity and Pregnancy Related Complications among Women Who Gave Birth at Jimma University Specialized Hospital, Jimma, Southwest Ethiopia. We compared the maternal and perinatal complications among grand multiparous and other multiparous women in Dar es Salaam in Tanzania. Antepartum hemorrhage and postpartum hemorrhage (for more information, see our page on maternal bleeding) 2. Please enable it to take advantage of the complete set of features! 1211-1217. Grand multipara: The term "multipara" applies to any woman who has given birth 2 or more times. HHS While multiparity is associated with precipitate labor, increased risk of hemorrhage (bleeding) and amniotic fluid embolism (the fluid that surrounds the baby enters mother‘s bloodstream), grandmultiparity is significantly associated with antenatal anemia (a decreased number of circulating red blood cells; Pic 1), multiple pregnancy, fetal macrosomia (birth-weight over 4,000 g), … Between January 1, 1995, and December 31, 2001, there were 299,710 live, singleton births in Utah women, aged 18 years and older, including 4,937 (1.6%) births to grand multiparas younger than 35 years of age and 6,414 (2.14%) births to grand multiparas, aged 35 and older. The past century has seen remarkable progress in improving the safety of childbirth in the United States. 1999; 181: 669-74. in minimal difference in pregnancy performance between 5. The clinical outcome in pregnancies of grand grand multiparous women. BJOG 2002;109:249–53. 800-638-3030 (within USA), 301-223-2300 (international) [email protected]. These variables were created to evaluate whether grand multiparity is a risk factor for any intrapartum or newborn complication. If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription. Grand (parity 5–9) and great grand multiparas (parity ≫ 10) were also compared with nulliparas to determine which group was at higher risk. Reasons for current pregnancy amongst grand multiparous Gambian women - a cross sectional survey. Soc Biol 1995;42:22–35. Results: When adjusted for maternal age, high birth order remained strongly associated with the occurrence of peripartum complications. COVID-19 is an emerging, rapidly evolving situation. 2.Toohey JS, Keegan Jr, KA, Morgan, MA, Francis J, Task S, deVeciana, M. The ‘′dangerous multipara’’: fact or fiction? Results: On the subject of grand multiparity 19 comparative studies could be identified, of these 9 used para 5 to 9 as the definition of grand multiparity. Pregnancy outcome has been shown to be poorer among women of low social class, and these poor outcomes are worsened by complications of grand multiparity. 16.Gortzak-Uzan L, Hallak M, Press F, Katz M, Shoham-Vardi I. Teenage pregnancy: risk factors for adverse perinatal outcome. In addition, young grand and great grand multiparas are at lower risk than young nulliparas for many intrapartum and newborn complications. By continuing to use this website you are giving consent to cookies being used. Great grand multipara have been reported to have an increased incidence in obstetric complications such as fetal malpresentation, placental abruption, dysfunctional labor and postpartum hemorrhage. Higher birth order remained an independent risk factor for peripartum complications after adjustment for maternal age. Great grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=2.6, P<0.001), labour dystocia, second stage (OR=2.1, P<0.001), and perinatal mortality (OR=2.5, P<0.001). Complications 41 models.  |  Numerous obstetric complications have been independently associated with progressive maternal age, yet most studies of grand multiparity have failed to consider this potentially confounding effect in their analysis. Acta Obstet Gynecol Scand. They compared the risk of obstetric complications, neonatal morbidity, and perinatal death between the groups, using parity 1 as the referent group and controlling for a number of sociodemographic factors, including age. The risk for complications is lower in young grand multiparas than in older grand multiparas. The primary aim of the present study was to determine whether grand multiparity is independently associated with maternal and perinatal mortality, placental abnormalities, obstetric complications, and abnormal neonatal birthweight. Review of relative risk estimates for individual versus collapsed parity groups revealed consistent results; thus, the collapsed parity group 2–4 was also used for ease of presentation. These complications include gestational diabetes, hypertension, anemia, placental abruption, placenta previa, preterm labour, mal-presentation, mal-position, fetopelvic disproportion and intra-partum complication, uterine intertia, dysfunctional labour, uterine rupture, intrauterine death, marosomia and subsequent operative delivery with its consequent risk of maternal mortality and morbidity2,3. Please enable scripts and reload this page. peculiar high risk group, modern antenatal care resulted Am J Obstet Gynecol. J Obstet Gynecol 1987;157:738–42. Seven years of Utah birth certificate data were reviewed (1995–2001). We examined birth certificate indicators of sociodemographic and lifestyle factors, intrapartum complications, and neonatal outcomes in young women and compared the risk for these complications in young grand multiparas with the risk in older grand multiparas. Historically, the definition of grand multiparity has varied in the obstetric literature, as has the combination of complications included in various studies.  |  Grand multiparity remains a risk in pregnancy and is associated with an increased prevalence of maternal and neonatal complications (malpresentation, meconium-stained liquor, placenta previa and a low Apgar score) compared with other multiparous women who delivered at Muhimbili National Hospital. Natl Vital Stat Rep 2004;53(7):1–18. Self-reported alcohol use was not included in the final model because, when comparing Utah state birth certificate data with data from Utah Pregnancy Risk Assessment Monitoring System,17 we determined that alcohol consumption during pregnancy was likely underreported in the birth certificate database. Distribution of Sociodemographic and Lifestyle Factors by Parity and Age, Risk of Intrapartum and Newborn Complications by Parity in Young Women, Aged 18–34 Years, Comparison of the Risks for Intrapartum and Newborn Complications in Young (aged 18–34) and Older (aged 35+) Women of Parity 5 or Greater. 4–7 The term grand multipara … The models for all intrapartum complications and most newborn complications were also adjusted for induction of labor, augmentation of labor, preeclampsia, and gestational diabetes. Seven years of de-identified Utah state birth certificate data were used in this retrospective population-based study, which included live singleton births occurring between January 1, 1995, and December 31, 2001 (n = 299,710). von Schmidt auf Altenstadt JF, Hukkelhoven CW, van Roosmalen J, Bloemenkamp KW. A woman who has given birth 5 or more times is called a grand multipara. Int J Gynaecol Obstet. Deliveries by women under 18 years of age were excluded from the study because there are unique risks associated with teenage pregnancy including preterm delivery, low birth weight, and higher infant mortality.15–17 This study was approved by the University of Utah Institutional Review Board. The study population consisted of 12 296 multiparous women (six deliveries or more) with singleton gestation. Young grand multiparas were not at significantly increased risk for a number of complications. Postpartum haemorrhage, postpartum anaemia, puerperal sepsis, and urinary tract infections were the postpartum complications found in the grand-multiparous population as it had been previously documented [3-6,18]. For a pregnancy to count as a "birth", it must go to at least 20 weeks' gestation (the mid-point of a full-term pregnancy) or yield an infant that weighs at least 500 grams, irrespective of whether the infant is liveborn or not. Ezra Y, Schmuel E, Hakim M, Schenker JG. None of the complications that were increased among grand multiparas in Bai et al’s study (antepartum hemorrhage, any obstetric complication, and neonatal morbidity as defined by admission to a neonatal intensive care unit) were found to be significantly associated with high parity among young grand multiparas in our study.10. In addition, very few studies have controlled for maternal age in their analyses, and none have examined the unique risks in young grand and great grand multiparas, despite evidence that advanced maternal age is an independent risk factor for a number of complications, including placenta previa,14,21–22 placental abruption,14,21–22 malpresentation,23 cesarean delivery,21,23 and prematurity.21,23, Using a methodology similar to ours, Bai et al10 used a population-based surveillance system to study 510,989 singleton births in New South Wales, Australia. Aquanaut 10 models. Calatrava 18 models. One mother in the grand multipara group died from dissecting aortic aneurysm during the puerperium. There is some indication that grand multiparity increases the risk of the following obstetrical complications: 1. The rates of complications by age were also examined for trends. 1 Over the past 20 years, however, this decline has reversed. Deliveries in parity groups 5–9 and 10+ were collapsed into 2 categories because of the small number of events in these groups. Looking for ABOG articles? Great grand multiparity: is it a risk? 18.Centers for Disease Control and Prevention. Maternal mortality fell from 850 per 100,000 live births in 1900 to 7.7 per 100,000 in 1997. Grand multiparity: is it still a risk in pregnancy? 14.Bobrowski RA, Bottoms SF. The rates of intrapartum and newborn complications in young grand multiparas (aged 18–34 years) were compared with those in women of lower parity. Underappreciated risks of the elderly multipara. Young grand multiparas were less likely to experience many complications than their older counterparts. Clipboard, Search History, and several other advanced features are temporarily unavailable. Int J Gynaecol Obstet 1995;50:17–9. Twenty~4 11 models. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. St. Louis (MO): Mosby; 1998. In addition, young grand multiparas were more likely to report having used tobacco (7.0% versus 2.5%, P < .001) during pregnancy. Theimpact of maternal age on pregnancy and its outcome. Visit our ABOG MOC II collection. Huge multiparity was associated with a higher rate of maternal and peripartum complications than grand multiparity. Huge multiparous women also had a higher rate of the following complications than grand multiparous women: cesarean section (14.4% versus 10.4%, P<.01), chronic hypertension (7.9% versus 3%, P<.001), severe pregnancy induced hypertension (2.6% versus 1.1%, P<.01), diabetes class A (10.7% versus 7.5%, P<.005), diabetes class B-R (4.3% versus 2%, P<.01) congenital anomalies (3.3% versus 2.6%, P<.05) … Objective: All registration fields are required. Data is temporarily unavailable. Obstetric problems in the grand multipara: a clinical study of 1330 cases. We have no reason to believe that differential underreporting occurred by parity in these data; thus, underreporting should not affect the quality of our reported risk ratios. Patients were classified into two groups according to the birth order: grand multiparous (between six and nine deliveries) and huge multiparous (ten or more deliveries). The rates of complications with each level of parity were initially examined for trends. Int J Gynaecol Obstet 1992;38:281–6. This may result in an underestimation of parity and, subsequently, an additional underestimation of risk in older and higher parity women. In his 1934 article, Solomons wrote, “My main object is to remove, if possible, once and for all, the idea that a primigravida means a difficult labor but a multipara means an easy one. An additional limitation of this study involves the definition of parity. The authors thank Nan Streeter, Lois Bloebaum, and Shaheen Hossain for their help in designing the study and providing the Utah state birth certificate data. Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric risk factors. Grand Complications 35 models. 1 time(s). Please try after some time. Obstetrics & Gynecology106(3):454-460, September 2005. Grand multiparous women show more obesity, gestational diabetes and chronic hypertension but less pre-eclampsia). This article has been cited Great grand multiparas were not at significantly increased risk for the remainder of complications, but there was insufficient power to detect differences because of the small number of great grand multiparas included in this analysis (Table 2). 23.Lehmann DK, Chism J. Pregnancy outcome in medically complicated and uncomplicated patients aged 40 years or older. No validation studies have been conducted on Utah birth certificate data, but a small number of complications have been compared with self-reports obtained through the Utah Pregnancy Risk Assessment Monitoring System.19 In this comparison, 95.1% agreement was reported for gestational diabetes, and 93.6% agreement was reported for placenta previa and placental abruption. The rate of peripartum complications was higher in huge multiparous than in grand multiparous women: malpresentation (6.2% versus 5%, P<.005), massive hemorrhage (0.7% versus 0.4%, P<.001) and dysfunctional labor (6.4% versus 3.5%, P<.001). Their study included 6,884 deliveries in women of parity 5 or greater. your express consent. When compared with young primiparas, young grand multiparas are at significantly increased risk only for preterm delivery, but at significantly decreased risk for a number of intrapartum complications. , Chayen B multiparity has varied in the control group to take advantage of the study the. Conclusion: women with high birth order are at increased risk for complications is lower in young grand multiparity complications!, Atwal GS, Maresh M. Grandmultiparae in a population with late and regulated childbearing: 1991., use your username or email along with your password to log in are at increased risk most! 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