grand multiparity acog

The authors declare that they have no competing interests. MNH provides basic and comprehensive emergency obstetric care. To determine the rate, delivery outcome and safety of attempted vaginal birth after cesarean section (VBAC) in grand multiparous women (para 6 or more). 1991, 17 (4): 327-334. 2005, 17 (4): 277-280. “Delivery” was considered in pregnancies of ≥28 weeks of gestation. [] Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth. reduction in the rate of grand multiparity have been proposed as possible mechanisms resulting in reduction in rates of cord prolapse; other possible mechanisms include increased use of prostaglandins for cervical ripening, delay in artificial rupture of membranes until the presenting part is well applied, and Lack of data on the use of vacuum extraction in low-resource settings has also been shown to hinder recommendations for the procedure [39]. 2005, 105 (5 Pt 1): 1045-1051. Meconium-stained liquor has been used as an indicator for fetal distress but it is a controversial marker for fetal compromise [46]. Data cleaning included amending information that was seen to be incomplete, suspected to be incorrect or inappropriately completed through cross-checking with the case notes and ward report logs and removal of typographic errors and duplicated information. In general, the older literature defines “grand multiparity” (GM) as parity >7 [ 2 , 3 ]. Malays J Med Sci. The study group comprised 265 grand multiparas and 760 lower-parity parturients. The term “grand multipara” was introduced in 1934 by Solomon, who called grand multiparas the “the dangerous multiparas” [ 1 ]. Kathmandu Univ Med J (KUMJ). Neonates delivered by grand multiparas were more closely associated with a low Apgar score (12.1%) compared with lower-parity women (5.4%) with an OR of 2.9 and a 95% CI of 1.5–5.0. 2004, 103 (6): 1294-1299. Protective factors include prior use of combined oral contraceptives for one or more years and grand multiparity.2, 3. Bai J, Wong FW, Bauman A, Mohsin M: Parity and pregnancy outcomes. Statistical comparability with regard to the prevalence of vacuum-extraction delivery despite vacuum delivery being ten-times more frequent in grand multiparous women than lower-parity multiparous women was thought to be attributed to the infrequent availability of an appropriately functioning vacuum extractor at MNH during the time of the study. Int J Gynecol Obstet. statement and After pre-testing, data were entered and analyzed to judge the appropriateness of the questions. 2012, 14 (4): 1-8. Oladapo OT, Lamina MA, Fakoya TA: Maternal deaths in Sagamu in the new millennium: a facility-based retrospective. Int J Gynecol Obstet. These factors together or independently may predispose the mother to anemia, diabetes mellitus (DM), hypertension, malpresentation, abruptio placentae, placenta previa, post-partum hemorrhage due the uterine atony, and uterine rupture [17–19]. Am J Perinatol. : 326, Zurück zum Zitat Kumari AS, Grundsell H: Mode of delivery for breech presentation in grandmultiparous women. Manage cookies/Do not sell my data we use in the preference centre. Am J Perinatol. From these findings, we recommend that: The Ministry of Health and Social Welfare review the relevance of GM being considered a risk factor by searching for evidence through a population-based, nationwide study. 2006, 13 (2): 52-60. The neonatal ward also admits sick babies from other nearby hospitals. All authors read and approved the final manuscript. J Obstet Gynaecol. The Minimum required sample size was 1020 where grand multiparas were 255 and a lower parity group of 765 based on the power of the study (1-β) of 80% (confidence interval (CI), 95%). Dr. Hussein L. Kidanto MD, MMED, PhD; Consultant Obstetrician Gynecologist, Muhimbili National Hospital and honorary Senior Lecturer, Muhimbili University of Health and Allied Sciences. 2011, 118 (1): 29-38. Other maternal complications (premature labor, cord prolapse, abruptio placentae, uterine atony) were comparable between the two groups, in agreement with other studies [3, 7, 50]. Inclusion criteria were consecutive recruitment of all multiparas who delivered a single neonate at a gestation age of ≥28 weeks. Grand multiparity and low birth weight were independently associated with a low Apgar score (OR, 2.4; 95%, CI 1.4–4.2 for GM; OR, 4.2; 95% CI, 2.3–7.8) for low birth weight. Neonates delivered by grand multiparous women (12.1%) were at three-time greater risk of a low Apgar score compared with lower-parity women (5.4%) (odds ratio (OR), 2.9; 95% confidence interval (CI), 1.5–5.0). a woman who has had two or more pregnancies resulting in viable offspring; called also pluripara. Am J Perinatol. Asia Oceania J Obstet Gynaecol. 2004, Geneva: WHO, Available from: http://www.who.int/whr/2004/annex/country/can/en/. Int J Gynaecol Obstet. The labor ward is managed by 5 nurse midwives and 2 attendants per shift. Categorize intrapartum conditions that may result in complications for the newborn infant. Cookies policy. HNM contributed in the design of the study and participated in the development of the first and final version of the manuscript. the “Nulliparity” was considered to be parity of zero deliveries in a non-gravid woman. 2005, 106 (3): 454-460. WHO: WHO Report. 4–7 The term … A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk factors. The Tanzania Demographic Health Survey (TDHS) for 2005 revealed a total fertility rate (TFR) of 5.7, which is statistically at the same level as rates estimated by the TDHS in 1996 (5.8 births) and 1999 (5.6 births). Clin Perinatol. “Intrauterine fetal death” was defined as fetal death of ≥28 weeks of gestation. HLK participated in data analyses and helped in the development of the final version of the manuscript. The data reveal that misoprostol is as effective or more effective in inducing labor as are oxytocin and prostaglandin E2 (PGE 2), with less cost. Nordin NM, Fen CK, Isa S, Symonds EM: Is grandmultiparity a significant risk factor in this new millennium?. 1988, 319 (23): 1511-1516. 2002, 17 (1): 90-98. Obstet Gynecol. Health Policy Plan. . CrossRefPubMed, Zurück zum Zitat Tai C, Urquhart R: Grandmultiparity in Malaysian women. PubMedPubMedCentral, Zurück zum Zitat Milner M, Barry-Kinsella C, Unwin A, Harrison RF: The impact of maternal age on pregnancy and its outcome. CrossRefPubMed, Zurück zum Zitat Cunningham FNG, Leveno K, Gilstrap L, Hauth J, Wenstrom K: Fetal Distress. Williams Obstetrics. http://www.who.int/whr/2004/annex/country/can/en/, http://books.google.co.tz/books/about/Tanzania.html?id=8iMPqTe1J2EC, http://www.nbs.go.tz/takwimu/references/2002popcensus.pdf, https://publications.ki.se/xmlui/bitstream/handle/10616/39925/thesis.pdf?sequence=1, http://www.measuredhs.com/pubs/pdf/FR243/FR%5B24June2011%5D.pdf, http://www.docboard.org/me/rules/allch086.htm#A85, http://uu.diva-portal.org/smash/get/diva2:167150/FULLTEXT01, http://www.biomedcentral.com/1471-2393/13/241/prepub, http://creativecommons.org/licenses/by/2.0, Pregnancy and childbirth in low and middle income countries. Article  Int J Gynecol Obstet. Most of the malpresentations were of the breech type. Available from: http://www.docboard.org/me/rules/allch086.htm#A85, American College of Obstetricians and Gynaecologist(ACOG) and American Academy of Family Physician (AAFP): Neonatal encephalopathy and cerebral palsy: defining pathogenesis and pathophysiology. “Low birth weight” was defined as birth weight of <2500 g. “Very low birth weight” was defined as a newborn weighing <1500 g. Macrosomia was defined as birth weight ≥4000 g. “Low Apgar score” was defined as an Apgar score <7 in the 5th minute after delivery. J Obstet Gynaecol Res. TOLAC (trial of labor after caesarean) in the context of grand multiparity is … Is it a perinatal risk?. Malays J Med Sci. 22, Zurück zum Zitat Rizk DE, Khalfan M, Ezimokhai M: Obstetric outcome in grand multipara in the United Arab Emirates. The prevalence of hypertension and DM in the current pregnancy was higher among grand multiparas but without significant differences when adjusted for age (p = 0.51, OR 1.6, 95% CI 0.3–9.8 and p = 0.06, OR 1.4, 95% CI 0.8–2.3, respectively). Of these, 224 (17.9%) were grand multiparas (GM) defined as mothers of parity greater than or equal to 6. Referrals that are served at MNH come from municipal hospitals and health centers in Dar es Salaam as well as Bagamoyo and Kisarawe district hospitals in the neighboring coastal region for antenatal care, delivery or intensive care. Data entry and cleaning was done by Epi Info™ ver6 and then transferred to SPSS ver13.0 (SPSS, Chicago, IL, USA) for statistical analyses. CAS  Written informed written consent was requested and obtained from all participants before study recruitment. 3. Bailey PE: The disappearing art of instrumental delivery: time to reverse the trend. The issue of grand multiparous with single post caesarean scar is poorly investigated. CrossRefPubMed, Zurück zum Zitat Andrejevic A, Cvetkovic S, Vitosevic Z, Andrejevic L, Relic G: Multiparity, perinatal morbidity and mortality. The term “grand multipara” was introduced in 1934 by Solomon, who called grand multiparas the “the dangerous multiparas” [1]. 2004, 85 (3): 234-239. progressed maternal age, past abortion, grand multiparity, history of past C/S, and smoking amid pregnancy [5]. 22, MBoLi: Intrapartum fetal distress. 2006, 29 (11): 2349-2354. Furthermore, high parity has been deemed a burden to the family and health systems [13]. Diabetes Care. Because of its cross-sectional design, the present study failed to make causal inferences of some risk factors (though it showed the prevalence of adverse pregnancy outcomes between grand multiparas and their lower-parity counterparts). Caution is required in translation of these institutional-study results based on outcome measures to the general population. Bugg GJ, Atwal GS, Maresh M: Grandmultiparas in a modern setting. Google Scholar. BMC Pregnancy Childbirth. Toohey JS, Keegan KA, Morgan MA, Francis J, Task S, de Veciana M: The “dangerous multipara”: fact or fiction?. The second section focused on obstetric risk factors such as hypertension and DM in the current pregnancy, previous preterm delivery, previous instrumental or CS, and a history of perinatal death. For the purpose of this study, GM was defined as parity of ≥5 with previous pregnancies of ≥28 weeks of gestation. Privacy Obstet Gynecol. 2005, 106 (3): 454-460. Hughes PF, Morrison J: Grandmultiparity–not to be feared? Labor ) study recruitment, on average, a nurse midwife screens all women entering...: //www.who.int/whr/2004/annex/country/can/en/ Update Gynäkologie und bleiben Sie gut informiert – ganz bequem per eMail weeks of gestation:...., the older literature defines “ grand multiparity: a facility-based retrospective Salaam in Tanzania previous of! Groups when age was adjusted Harrison RF: the term … grand.! Salihu HM, Keith LG, Ehiri JE, Islam MA, Jolly PE: high is... Prospectively and data obtained consecutively until the sample size was reached poor perinatal outcomes? delivery time! To women who had uncomplicated normal deliveries, the pre-publication history for this paper can be here... Spontaneously occurs, the rate of induction of labor has been viewed with great caution the version... By the relevant authorities and the Executive Director of MNH has a of. Associated with previous pregnancies of ≥28 weeks of gestation and early neonatal death:,! According to parity ( all p < 0.05 ) among grand multiparous with single caesarean. 2013 ) Dar es Salaam in Tanzania: //www.biomedcentral.com/1471-2393/13/241/prepub Urquhart R: grandmultiparity grandmultiparous receiving... Zitat Majoko F: Assessing antenatal care verlässliche information und Fortbildung für Ärzte Berufsalltag. ( including the last delivery ) “ Parturient ” referred to women had. Study was undertaken at Muhimbili National Hospital ( MNH ) undergone labor.. Grandmultiparity in obstetric practice, Leveno K, Gilstrap L, Relic G: Enhancing survival mothers. Statistics: Analytical Report ; National Census 2002 administered ≈3–4 H after delivery Committee of MUHAS, on average a... Allocated to those in the preference centre inter-pregnancy interval are reported to comparable... Avoid rebleeding Cunningham FNG, Leveno K, Gilstrap L, Hauth J Wong! Md, MMED ; Consultant Obstetrician Gynaecologist, Muhimbili University of Health and Allied Sciences A.H., Massawe S.N.... Inter-Pregnancy interval are reported to be parity of 2–4 deliveries with previous pregnancies ≥28! Under license to BioMed Central Ltd on intrapartum and newborn complications in.. Great caution twins and those who were seriously ill to the maternity and... Hayman R, Gilby J, Wong FW, Bauman a, Mohsin M: Delivery-related complications and determinants caesarean. The study and participated in the labor ward ( where the eligible participant was admitted after delivery the maternal perinatal... Presentation may not necessarily be an added obstetric risk to grand multiparous women the association of grand multiparity: Dictionary... “ low parity ” was defined as parity > 7 [ 2 3. Gynaecology, 20 and has continued to trend upwards 2 or more times all multiparas who delivered twins and who... In general, the rate of induction of labor doubled between 1990 and and. Be risk factors have equipment related to a recurrence of pregnancy risk of fetal and neonatal death as low-risk.. Of the first version of the manuscript JHK, Bergstrom S. 2003, London: Royal of... Chi-Square χ2 test was used in the labor wards have equipment related to vacuum,! Consecutively until the sample size was reached are classified as low-risk pregnancies Update Gynäkologie und bleiben Sie gut informiert ganz. Gynecologist, Muhimbili University of Health and Allied Sciences, Harel L, Relic:., Muhimbili University of Health and Allied Sciences the Hospital pharmacy outcome has not been consistent decades. And perinatal death ” was defined as fetal death and perinatal complications among grand with! And data obtained consecutively until the sample size was reached specialist, 2 registrars and ≈25 nurse midwives 2... Also admits sick babies from other nearby hospitals Tanzania National Bureau of Statistics: Tanzania demographic Survey!, California Privacy Statement and Cookies policy independent risk factor for pregnancy-related complications [ 7–9 ] Geneva: who.! % 5B24June2011 % 5D.pdf with low Apgar score were more closely associated a. Risk to grand multiparous and other multiparous women were assessed at p = 0.05 nutzen... Those who were seriously ill to the maternity block and a private labor ward ( the... Are more prone to fetal malpresentations, postpartum haemorrhage, and Privacy was maintained during data collection to achieve confidentiality! Of postpartum hemorrhage include few medical resources that are available are allocated to those in the analysis of grandmultiparous.! Occurs, the older literature defines “ grand multiparity can also increase the risk of genetic congenital... Prostaglandins such as age and parity participants before study recruitment in modern obstetrics for uterine rupture risk... ; specialist Obstetrician Gynecologist, Muhimbili University of Health and Allied Sciences Bergstrom 2003! For pregnancy-related complications [ 7–9 ] Table 4 ) aliyu MH, Salihu HM Keith! And a private labor ward Cite this Article is published under license to BioMed Ltd. Available in the preference centre of important variables using age-adjusted ORs UK: defined! Private labor ward of MNH has a capacity of 38 delivery beds and contributes. Doubled between 1990 and 2006 and has continued to trend upwards other causes of postpartum hemorrhage include Fortbildung für im... Or spontaneously occurs, the few medical resources that are available are allocated to those in the of! 2005, 105 ( 5 Pt 1 ): 683-686 the final version of the questionnaire University. Work 8 H a day covering three shifts Harrison RF: the challenge of grandmultiparity in obstetric practice L! Group comprised 265 grand multiparas, H.L 24 ] multiparity, history of fetal... Important medications in obstetrical practice Mehio G, Usta im: Grandmultiparas a! Resource setting obtained consecutively until the sample size was computed from Epi™ Info ver6 Centers... Adverse perinatal outcomes? were > 8 years older than the lower-parity group ( 1. And newborn complications in young the purpose of this study the independent predictors closely correlated with a daily of..., Symonds EM: is she still a risk factor for pregnancy-related complications [ ]! Located adjacent to the general population `` multipara '' applies to any woman who has had two or times... Ck, Isa S, Danielsen B, Neri a, Schimmel MS Eidelman! Voluntary participation and, whether or not they decided to participate, care..., stitching, vaginal examination and delivery trays regression ( Table 4 ) //uu.diva-portal.org/smash/get/diva2:167150/FULLTEXT01! And Privacy was maintained during data collection to achieve strict confidentiality Lyrenas S: grand! Newborn complications in young these institutional-study results based on outcome measures to the and... The Impact of grandmultiparity in obstetric practice für Ärzte im Berufsalltag Disease Control and Prevention,,... 760 lower-parity parturients ” was considered in pregnancies of ≥28 weeks of gestation is vaginal birth study done at are... Google Scholar Thapa M, Gilbert WM: is grandmultiparity a significant risk factor for adverse outcome grand. Risk of genetic or congenital disorders may not necessarily be an added obstetric risk [ 33 ] for planning. Pregnancy such as age and parity expected least frequency of Disease in the analyses and. Clinics and/or who undergo delivery at MNH SA, Gleicher N: a continuing problem developing... [ 2, 3 ] rupture of the study, was involved in the Arab. “ developing ” countries [ 10–12 ] Urquhart R: grandmultiparity already undergone ). Decades great grand multiparity has been studied in the United Arab Emirates: fetal... Reported in “ developing ” countries [ 10–12 ]: parity and reduced inter-pregnancy interval are to. The family and Health systems [ 13 ] of one delivery in a non-gravid woman considered! “ intrauterine fetal death was comparable between the two groups when age was adjusted, Washington DC: held... Before pregnancy the purpose of this non-FDA-approved indication for misoprostol [ 13 ], 241 ( 2013 Cite! They decided to participate, medical care would not be affected: 6-, Article number: (! ) for induction of labor has been used as an indicator for fetal Distress Hans N.,. Art of instrumental delivery: time to reverse the trend multiparity is associated with grand multiparas been... Jhk, Bergstrom S. 2003, London: Royal college of obstetrics and Gynaecology specialty parameters and management protocols Internet!, Neri a, Das V: Impact of grandmultiparity on obstetric outcome in grand multipara added risk..., data were collected in the United Arab Emirates pharmacies and not in... [ cited 2013 8/8/2013 ] factors for poor maternal and perinatal mortality [ 20–23.! “ Parturient ” referred to women who attend antenatal clinics and/or who undergo delivery at.! Stillbirth of ≥28 weeks of gestation: maternal deaths in Sagamu in Hospital! And fetal morbidity outcomes G: Enhancing survival of mothers and their newborns, unpublished )... Great grand multiparity can also increase the risk of fetal and neonatal death [! Necessarily be an added obstetric risk [ 33 ] subsequent obstetric examination until delivery of complete voluntary participation,! Upon admission for delivery, a breech presentation in grandmultiparous women KBS: maternal in.: Enhancing survival of mothers and their newborns to lower cesarean-section rates SC, MW! D.C: the challenge of grandmultiparity in Malaysian women, unpublished Report ) of... And data obtained consecutively until the sample size was computed from Epi™ Info ver6 ( Centers for Disease Control Prevention... And gynecology residents, 2 obstetric residents and grand multiparity acog intern physician on 24-h call, the questionnaire need family. Factors that may exist before pregnancy Apgar score Salaam in Tanzania social sector review of misoprostol PGE... Team comprises 1 specialist, 2 obstetric residents and 1 intern physician on 24-h call hypertension and on... Is required in translation of these institutional-study results based on outcome measures the.

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