RISKY GRAND MULTIPARAS

Grandmultiparity has long been classified as constituting a high risk factor in pregnancy. The complications associatedwith grandmultiparity have been divided into ante-partum, intra-partum and the postpartum. Intrapartum complications most commonlythought to be associated with grandmultiparity are malpresentations, placental disorders, postpartum hemorrhage and uterine rupture.Concerted effort should be instituted for effective family planning initiatives and specialized antepartum and intrapartum management.Objective: To determine the frequency of intrapartum complications and mode of delivery in grandmultipara. Material and Methods: Itis descriptive case series study conducted in department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals,Faisalabad from March 11, 2010 to September 10, 2010. Results: Grandmultipara women who fulfilled the inclusion criteria werestudied for intrapartum complications and mode of deliveries. One hundred and thirty nine patients were included in my study. Mean ageof the patients was 32.38 years. Mean gestational age for delivery was 37.06 weeks. Grandmultiparas had more intrapartumcomplications including malpresentation (19.4%), placental abruption (5.8%), placenta previa (8.6%), postpartum hemorrhage (6.5%)and ruptured uterus (1.4%). Mode of delivery was also assessed and 59%, 7.9 %, 31.7% of patients had normal vaginal delivery,instrumental vaginal delivery and cesarean section respectively. Conclusions: It is concluded that in the developing countries theincidence of grandmultiparity is still high with a significantly increased risk of complications. Grandmultiparity should be considered highrisk and needs active intervention by improving literacy, health care facilities, provision of safe and effective contraception andreproductive health status.