IMPACT OF GRAND MULTIPARITY ON MATERNAL AND FETAL HEALTH: A CROSS-SECTIONAL STUDY

Abstract

Background: Grand multiparity is the risk in pregnancy with increase maternal and fetal morbidity and mortality. Its prevalence is high among developing and under developed countries where mother- child health is neglected. Its risk factors have been identified but its impact on health outcomes of mother and child are still of concern.

Introduction: Grand multiparity has been considered an independent factor for increasing adverse outcome for both fetus and mother specially diabetes mellitus, antepartum hemorrhage, malpresentation, cesarean section rate, postpartum hemorrhage, iron deficiency anemia, and a high perinatal mortality rate.

Methodology: A descriptive cross sectional study was conducted on 500 pregnant females in the Department of Obstetrics and Gynaecology, Fauji Foundation Hospital, Rawalpindi. Study was carried out over a period of eight months from October 2019 to May 2020. After ethical approval from institute through purposive sampling data was collected among pregnant female fulfilling the inclusion criteria. Antenatal record was reviewed for any antenatal complications (like anemia, malpresentation and PIH). During labor patients were managed according to the unit protocol and portogram was used to monitor the progress of labor and like PPH, prolong labor, birth weight was measured. Data was analyzed for qualitative and quantitative variables, where age, gestational period and parity were presented with mean and standard deviation and percentage of C-section, postpartum hemorrhage, PIH, anemia, malpresentation and fetal outcome were analyzed. Chi- square test of significance( with p≤ 0.05) was used to determine the relation of grand parity with maternal and fetal outcome.

Results: Patients ranged between 25-45 years with mean age 36.59±4.12. Mean gestational age was 38.58±0.84 weeks. Majority of the patients were gravida 5-9. Pregnancy induced hypertension(PIH) developed in 123 patients, anemia in 197 patients (39.4%), malpresentation seen in 66 cases (13.2%), prolonged labor occurred in 35 cases (7%), Caesarean section was carried out in 189 cases (37.8%) while normal vaginal delivery observed in 311 patients (62.2%), Postpartum hemorrhage(PPH) seen in 53 patients (18%), macrosomia developed in 48 cases (9.6%). Stratification for age, gestational age and parity was carried out.

Conclusion: This study demonstrated that grand multiparity remains a major obstetrics problem. It is associated with pregnancy induced hypertension, anemia and cesarean section. In communities where large family is desirable it is important to address the value of family planning and conduction of meticulous antenatal care.