Khadija H Asaf.
Grand Multiparity: Still an Obstetric Risk Factor.
Pak J Obstet Gynaecol Jan ;10(1,2):24-8.

A prospective, parallel group controlled study of various complications faced by grand multipara was conducted at Lady Willingdon Hospital, Lahore from Ist January 1995 to June 1995. A total of 1000 grand multipara were included in the study. The prenatal, natal and post natal complications and maternal and perinatal mortality was assessed. The results were analyzed and compared with 1000 women of parity 2-4 (control group). The results showed high in incidence of anemia (80%). Cesarean section (38% vs 35%), inversion of uterus (0.2% vs nil) and rupture of uterus (0.2% vs nil), hypertension and PIH superimposed on chronic hypertension (12.5-25% vs 8-14%). The incidence of postpartum hemorrhage, abruptio placentae, preterm labour, obstructed labour, puerperal sepsis and wound infection was also high in grand multi parous group. There were 9 maternal deaths out of 1000 cases of study group as compared to 4 deaths in control group. Similarly the perinatal mortality rate was 180/1000 births as compared to 150/1000 in para 2-4. The grand multipara, therefore, continues to be a high risk obstetric factor that requires skilled obstetric care before, during and even after delivery. Community awareness, patient education andfamilyplanningadvice are some of the remedies to improve the maternal as well as perinatal outcome.

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