The "grand multipara"--is it a problem? A review of 5785 cases.

ABSTRACT

PIP: The grand multipara (GM) has almost disappeared in the Western countries due to the advancement of family planning. Having a heterogenous population, the problem of grand multipara still exists in Israel. This study is based on 5785 cases of grand multipara, which were treated in the obstetrical department of the Rambam Medical Center, Technion during a period of 16 years (1960-75). The authors compared this group to the general obstetrical population in terms of pregnancy and delivery complications. Face and breech presentations as well as transverse lie were twice, brow presentations were 3 times as frequent in the GM group. Postpartum hemorrhage was 4 times and premature separation of the placenta twice as frequent. Rupture of the uterus was about 20 times more frequent. Forceps delivery and Cesarean section rate were twice, while the vacuum extraction 5-fold more frequent. There was no maternal mortality, and perinatal mortality was not higher than in the general population. Even though the percentage of GM in this population has decreased in the last 10 years, the results suggest that grand multiparity is still a high risk obstetrical problem.