2004, 85 (3): 234-239. J Obstet Gynaecol. 1994, 44 (3): 211-217. 2001, 264 (4): 194-198. The mean age among grand multiparas was 35.15 ± 4.8 years whereas that for other multiparas was 27.86 ± 5.7 years (OR, 7.2; 95% CI, 6.6–7.9). A review of 5785 cases. . Department of Obstetrics and Gynaecology, Muhimbili National Hospital, PO Box 65000, Dar es Salaam, Tanzania, Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania, Siriel N Massawe, Hussein L Kidanto & Hans N Mgaya, You can also search for this author in 2011, 38 (1): 71-75. A woman who has given birth one or more times can also be referred to as para 1, para 2, para 3, and so on. Zurück zum Zitat The World Bank. Bai J, Wong FW, Bauman A, Mohsin M: Parity and pregnancy outcomes. CAS  4. An increasing prevalence of surgical deliveries seen in developed countries from the 1980s onwards is currently being realized in developing countries, including those in Sub-Saharan Africa [40–42]. 2004, Geneva: WHO, Available from: http://www.who.int/whr/2004/annex/country/can/en/. Am J Obstet Gynecol. Cite this article. 2002, 22 (6): 604-609. Predictors of adverse outcomes in relation to grand multiparous women were assessed at p = 0.05. Written informed written consent was requested and obtained from all participants before study recruitment. Am J Obstet Gynecol. Women who did not consent to join the study were also excluded. A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk factors. “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. Grand multiparity remains a risk in pregnancy and is associated with an increased prevalence of maternal and neonatal complications (malpresentation, meconium-stained liquor, placenta previa and a low Apgar score) compared with other multiparous women who delivered at Muhimbili National Hospital. The principal investigator and two research assistants collected data throughout the day as recruitment proceeded. 2005, 105 (5 Pt 1): 1045-1051. Grand multiparity (delivery of ≥ 5 viable fetuses) Relaxant anesthetics. 2002, 186 (2): 274-278. 1988, 158 (2): 389-392. Retained placental tissues. Sixty-to-eighty percent of women who attend antenatal clinics and/or who undergo delivery at MNH are classified as low-risk pregnancies. Grand multiparity can also increase the risk of uterine rupture. Nicholson WK, Asao K, Brancati F, Coresh J, Pankow JS, Powe NR: Parity and risk of type 2 diabetes: the Atherosclerosis Risk in Communities Study. CrossRefPubMed, Zurück zum Zitat Wilkinson D, Cutts F, Ntuli N, Abdool Karim SS: Maternal and child health indicators in a rural South African health district. Lyrenas S: Labor in the grand multipara. progressed maternal age, past abortion, grand multiparity, history of past C/S, and smoking amid pregnancy [5]. Grand multiparity is associated with a higher complication rates in comparison to lower parity counterparts[1-5]. 2005, Available from: http://uu.diva-portal.org/smash/get/diva2:167150/FULLTEXT01, The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/13/241/prepub. MNH is a National referral hospital which also serves as a teaching hospital for the Muhimbili University of Health and Allied Sciences (MUHAS). O09.41 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Obstet Gynecol. There are two obstetric operating theatres located adjacent to the maternity block and a private labor ward (IPPM Annex). 2–5 As a matter of fact, several retrospective studies have reported increased complication rates, such as diabetes, 2,4,6 threatened premature labor, 2 perinatal mortality, 2,7,8 hypertension, 4 and intrauterine fetal death. Participants were assured of complete voluntary participation and, whether or not they decided to participate, medical care would not be affected. Hughes PF, Morrison J: Grandmultiparity–not to be feared? CrossRefPubMed, Zurück zum Zitat Cunningham FNG, Leveno K, Gilstrap L, Hauth J, Wenstrom K: Fetus at high risk of genetic or congenital disorders. statement and CrossRefPubMed, Zurück zum Zitat Aliyu MH, Salihu HM, Keith LG, Ehiri JE, Islam MA, Jolly PE: High parity and fetal morbidity outcomes. 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]. 2010, Maryland USA: IFC Micro, [cited 2013 8/8/2013]. Obstet Gynecol. However, a high prevalence of CS (35–40%) cannot go unnoticed. adj., adjmultip´arous. PubMed  Despite good coverage of healthcare in Tanzania (90% of the population is <10 km from a healthcare facility), provision of health services remains inadequate because of poor accessibility and lack of equipment within health facilities [16]. 34, 65-79. CrossRefPubMed, Zurück zum Zitat Majoko F, Nyström L, Munjanja S, Lindmark G: Usefulness of risk scoring at booking for antenatal care in predicting adverse pregnancy outcome in a rural African setting. The sample size was computed from Epi™ Info ver6 (Centers for Disease Control and Prevention, Atlanta, GA, USA). Zurück zum Zitat Rayamajhi R, Thapa M, Pande S: The challenge of grandmultiparity in obstetric practice. A total of 1809 multiparous women delivered during the study period. 1985, 23 (4): 321-326. To determine the rate, delivery outcome and safety of attempted vaginal birth after cesarean section (VBAC) in grand multiparous women (para 6 or more). The researchers reviewed the clinical notes (including the partogram) to extract information according to the variables of interest laid down by the standard questionnaire. Most of the malpresentations were of the breech type. 2002, 100 (6): 1190-1195. 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]. This was a prospective cross-sectional study done at MNH. Clin Perinatol. 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 For that reason, it is important to note that some studies [31, 32] have associated high parity with an elevated risk to the pregnancy without adjusting for age in the analysis. 1985, 23 (4): 321-326. Caution is required in translation of these institutional-study results based on outcome measures to the general population. Int J Gynaecol Obstet. Predictors for adverse outcome in relation to grand multiparas were assessed using logistic regression analyses. Obstet Gynecol. Tanzania Journal of Health Research. Hayman R, Gilby J, Arulkumaran S: Clinical evaluation of a “hand pump” vacuum delivery device. 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. Grand multiparity can also increase the risk of uterine rupture. 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). PubMedPubMedCentral, Zurück zum Zitat Milner M, Barry-Kinsella C, Unwin A, Harrison RF: The impact of maternal age on pregnancy and its outcome. 1998, 25 (3): 529-538. 1993, 41: 17-22. Moreover, a study completed in rural Tanzania revealed that ≤60% of health workers were unaware of the definition of GM [15]. 2005, United States of America: McGRAW-HILL, 314-315. All eligible multiparas were recruited prospectively and data obtained consecutively until the sample size was reached. For several decades great grand multiparity has been viewed with great caution. The nurses and support staff work 8 h a day covering three shifts. Of these, 224 (17.9%) were grand multiparas (GM) defined as mothers of parity greater than or equal to 6. Am J Obstet Gynecol. Myers SA, Gleicher N: A successful program to lower cesarean-section rates. The unmet need for family planning is ≥20%. Priorities in the allocation of health-service resources based on disease burden and evidence-based medicine within the health sector includes the identification of women whose pregnancies are at increased risk of complications. Williams Obstetrics. , Urquhart R: grandmultiparity: a continuing problem in developing countries have been considered risky the.! Tendency could be related to a recurrence of pregnancy such as intrauterine fetal death of weeks... 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