GRAND-MULTIPARITY AND ITS FETO-MATERNAL OUTCOMES IN A TERTIARY CARE HOSPITAL

Abstract

Background: In developed economies with excellent obstetric facilities, standard perinatal care and wholesome health‑seeking behavior, the prevailing reports indicate that obstetric complications among grand multipara are now independently associated with progressive maternal age and not parity. Unlike the rich‑resource settings with satisfactory outcomes in developed countries, where these confounders are either nonexistent or reduced to an insignificant level; in poor‑resource settings, there are increased adverse obstetric outcomes in high parity pregnancy.

Methodology: All grand multiparous women who got admitted in the Obstetrics & Gynaecology Department of Government Medical College & Hospital, Jammu from November 2019 to October 2020 and fulfilled the inclusion criteria for the study, were taken as cases. They were compared with an equal number of primigravidas or multiparous women, who formed the control group, chosen by taking every next woman who got admitted after a grand multipara.

Results: Stratification of the study population according to age showed that grand multiparous females were more likely to be of advanced age with P-value <0.001, and therefore, significant. Grand multiparous women were more likely to deliver at an earlier gestational age. Most of the grand multiparous women (65.2%) in this study delivered vaginally. Majority of the patients in both the groups (59% in cases and 54.5% in controls) went into spontaneous labour. Out of all the complications, grand multiparas were more likely to develop severe anemia (p-value 0.005), gestational hypertension (p-value 0.028) and eclampsia (p-value 0.043) as compared to women with lower parity, with a significant difference. Grand multiparous women were more likely to have a lower Apgar score at 5 minutes (<7) compared to non-grand multiparas. The compound presentations seen in grand multiparas were hand prolapse (in 3 cases) and cord prolapse (in 3 cases). The other intra partum complications in the two groups were not of statistical significance. After comparing perinatal complications in cases and controls, it was found that cases were more likely to develop these complications, out of which preterm birth (p-value 0.019), intra uterine death (p-value0.003), early neonatal death (p-value 0.034) and low birth weight (p-value 0.031) were statistically significant.

Conclusion: The present study shows that there is a significant increase in feto-maternal complications like anemia, hypertensive disorder, PPH, preterm deliveries, IUFD, etc. in these pregnancies, leading to severe morbidity in mother and fetus. Thus, there is a need for proper pregnancy evaluation, regular antenatal visits, intra partum care and post natal follow up to improve pregnancy outcome of all high risk pregnancies. In addition to this, we need to increase community awareness on its risks and encourage birth control among older women.