Grand multipara refers to a pregnant woman who has given four or more previous viable births. Grand multipara is considered a high-risk case.
The incidence has been gradually declining over a couple of decades due to acceptance of small family norms but it is still prevalent in developing countries and causes of maternal death.
Risks or Complications
There are many risks associated with grand multipara during pregnancy, labour and puerperium.
Pregnancy
There is an increased incidence of
- Miscarriage either spontaneous or induced
- Malpresentation due to pendulous abdomen
- Multiple pregnancies
- Placenta previa
- Anaemia
- High blood pressure
- Prematurity
- Haemorrhoids and varicose veins
Labour
- Cord prolapse due to malpresentation and high floating head at the onset of labour
- Big size of the baby
- Obstructed labour due to malpresentation, malposition and cephalopelvic disproportion
- The uterus may rupture if the obstruction remains undetected and left uncared for
- Postpartum haemorrhage due to atonic uterus
- Development of shock due to ill health, bleeding or unrecognised uterine rupture
- Risk of operation because of the complications.
Puerperium
- Subinvolution (failure of the uterus to revert to its original state)
- Failure of lactation
- Increased intranatal hazards.
Management
The cases are considered as high risk and they require adequate antenatal care and should have a mandatory hospital delivery.
During labour, the following guidelines are prescribed-
- Presentation and position are to be checked
- Pelvic assessment should be done as a routine
- Undue delay in the progress of labour should be viewed with concern
- Be cautious against postpartum haemorrhage
- Labour should be conducted by experienced personnel only.
Grand multiparity has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk.
If you have four or more previous viable births and are pregnant again then no need to worry. Have regular antenatal checkups and get the delivery done in the hospital. If you have proper antenatal and intranatal care then there will be no problem with the pregnancy and your health.
Conclusion
In the above post, we have discussed the risks associated with grand multipara. Grand multiparity is considered as high-risk case but if a woman gets proper perinatal and antenatal care, then women with high-parity rates are no longer at high risk. They can have safe pregnancy and delivery of a healthy baby.
