CrossRefPubMed, Zurück zum Zitat Roman H, Robillard PY, Verspyck E, Hulsey TC, Marpeau L, Barau G: Obstetric and neonatal outcomes in grand multiparity. In the absence of clear and consistent evidence of the association of GM with adverse pregnancy outcomes, classifying grand multiparas as a high-risk group could increase the cost burden to families and health systems as well as physical and psychological stress to the mother and family. “Multiparity” was defined as parity of ≥2 deliveries. S Afr Med J. For many decades pregnancies in grand multiparas have been considered risky. PubMed Central  AHM participated in design of the study, carried out the collection and analyses of data, and drafted the first and final version of the manuscript. 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. 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 CrossRefPubMed, Zurück zum Zitat Seoud MA, Nassar AH, Usta IM, Melhem Z, Kazma A, Khalil AM: Impact of advanced maternal age on pregnancy outcome. BMC Pregnancy Childbirth. 1999, Washington D.C: The World bank, 60. Bestellen Sie unseren kostenlosen Newsletter Update Gynäkologie und bleiben Sie gut informiert – ganz bequem per eMail. In the absence of other obstetric indications for CS (e.g., footling, previous scarring, cord prolapse or prematurity) grand multiparas have a better performance in breech delivery than lower-parity women [49]. Conversely, the association of a history of increased pregnancy loss with high parity could also be influenced by the need of the mother with previous fetal or neonatal loss to compensate for such a loss by attempting a successful pregnancy. Am J Obstet Gynecol. 2002, 17 (1): 90-98. 1995, 61 (2): 105-109. Arch Gynecol Obstet. 2005, 17 (4): 277-280. N Engl J Med. The researchers reviewed the clinical notes (including the partogram) to extract information according to the variables of interest laid down by the standard questionnaire. Asia Oceania J Obstet Gynaecol. GM and low birth weight were independently associated with a low Apgar score (p = 0.001, OR, 2.4; 95% CI, 1.4–4.2 for GM; p = 0.002, OR, 4.2; 95% CI, 2.3–7.8 for low birth weight). 2011, 37 (8): 1015-1019. Hence, the few medical resources that are available are allocated to those in the greatest need. Obstet Gynecol. For participants who had uncomplicated normal deliveries, the questionnaire was administered ≈3–4 h after delivery. Rayamajhi R, Thapa M, Pande S: The challenge of grandmultiparity in obstetric practice. 22, Zurück zum Zitat MBoLi: Intrapartum fetal distress. Dar es Salaam has, according to the 2002 census, a population of ≈2.5 million and an annual growth in population of 4.3% [23]. The mode of delivery did not differ significantly according to parity (all p > 0.69). Lyrenas S: Labor in the grand multipara. Int J Gynecol Obstet. “Delivery” was considered in pregnancies of ≥28 weeks of gestation. 9 However, in … grand multiparaa woman who has had six or … A case control study. © 2020 BioMed Central Ltd unless otherwise stated. Edited by: Cunningham F e. 2005, United States of America: McGraw-Hil, 461-462. The Student’s t-test was used to analyze continuous variables. Zurück zum Zitat Mdegela M, Muganyizi P, Pembe A, Simba D, Van Roosmalen J: How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania?. Obstet Gynecol. A reasonable definition of "grand multiparity" is a woman who has had ≥5 births (live or stillborn) at ≥20 weeks of gestation, with "great grand multiparity" defined as ≥10 births (live or stillborn) ≥20 weeks of gestation . CrossRefPubMed, Zurück zum Zitat Hayman R, Gilby J, Arulkumaran S: Clinical evaluation of a “hand pump” vacuum delivery device. Percentage age distribution of the study population. Bai J, Wong FW, Bauman A, Mohsin M: Parity and pregnancy outcomes. Extension of an episiotomy. A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk factors. Edited by: Cunningham FEA. the “Nulliparity” was considered to be parity of zero deliveries in a non-gravid woman. Oladapo OT, Lamina MA, Fakoya TA: Maternal deaths in Sagamu in the new millennium: a facility-based retrospective. CrossRefPubMed, Zurück zum Zitat Aliyu MH, Salihu HM, Keith LG, Ehiri JE, Islam MA, Jolly PE: High parity and fetal morbidity outcomes. SNM participated in the design of the study, was involved in the analyses, and drafted the first version of the manuscript. a woman who has had two or more pregnancies resulting in viable offspring; called also pluripara. CrossRefPubMed, Zurück zum Zitat Cunningham FNG, Leveno K, Gilstrap L, Hauth J, Wenstrom K: Fetal Distress. This is a retrospective case-control study, performed at King Abdulaziz university hospital, the charts of 405 grand multiparous women with previous caesarean section were reviewed to determine rate and delivery outcome of attempted VBAC. Written informed consent was obtained from all parturients who met the inclusion criteria. List maternal risk factors that may exist before pregnancy. Short description: Suprvsn of pregnancy w grand multiparity, first trimester The 2021 edition of ICD-10-CM O09.41 became effective on October 1, 2020. CrossRefPubMed, Zurück zum Zitat Harrison KBS: Maternal care in developing countries. The term “grand multipara” was introduced in 1934 by Solomon, who called grand multiparas the “the dangerous multiparas” [ 1 ]. The nurses and support staff work 8 h a day covering three shifts. 2002, 53 (1): 6-12. CrossRefPubMed. Google Scholar. 1. 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. 2002, 17 (1): 90-98. Univariate analyses of antenatal profiles and obstetric risk factors (Table 1) showed grand multiparas to have a later booking for antenatal clinics (gestational age, 21.45 ± 5.9 weeks) compared with lower-parity women (19.49 ± 5.7 weeks) with an OR of 1.9 and 95% CI of 1.1–2.7. As shown in previous studies [4], neonates born with low Apgar score were more closely associated with grand multiparas. 1995, 61 (2): 105-109. https://doi.org/10.1186/1471-2393-13-241, DOI: https://doi.org/10.1186/1471-2393-13-241. 1988, 319 (23): 1511-1516. 1995, 172 (2 Pt 1): 683-686. CAS  Sixty-to-eighty percent of women who attend antenatal clinics and/or who undergo delivery at MNH are classified as low-risk pregnancies. Simonsen SM, Lyon JL, Alder SC, Varner MW: Effect of grand multiparity on intrapartum and newborn complications in young. Available from: http://​www.​docboard.​org/​me/​rules/​allch086.​htm#A85, http://​www.​docboard.​org/​me/​rules/​allch086.​htm#A85, Zurück zum Zitat American College of Obstetricians and Gynaecologist(ACOG) and American Academy of Family Physician (AAFP): Neonatal encephalopathy and cerebral palsy: defining pathogenesis and pathophysiology. Am J Obstet Gynecol. HNM contributed in the design of the study and participated in the development of the first and final version of the manuscript. To determine the rate, delivery outcome and safety of attempted vaginal birth after cesarean section (VBAC) in grand multiparous women (para 6 or more). All eligible multiparas were recruited prospectively and data obtained consecutively until the sample size was reached. A cross-sectional study was undertaken at Muhimbili National Hospital (MNH). A review of 5785 cases. Rapid labor. The labor wards have equipment related to vacuum extraction, stitching, vaginal examination and delivery trays. Diabetes Care. Structure of Tanzania household: In Tanzania social sector review. CrossRefPubMed, Zurück zum Zitat Cunningham FNG, Leveno K, Gilstrap L, Hauth J, Wenstrom K: Fetus at high risk of genetic or congenital disorders. 2010, Maryland USA: IFC Micro, [cited 2013 8/8/2013]. All authors read and approved the final manuscript. 2005, 106 (3): 454-460. WHO: WHO Report. Viable gestational age varies from region to region. p = 0.05 was considered significant. Written informed written consent was requested and obtained from all participants before study recruitment. Article  GM has also been associated with previous loss of pregnancy such as intrauterine fetal death and perinatal death [24]. PubMed  A low prevalence of hypertension and DM among our participants could be attributed to a lack of statistical significance despite a twofold greater likelihood of grand multiparas having hypertension and DM than their lower-parity counterparts. 1993, 41: 17-22. CrossRefPubMedPubMedCentral. Available from http://​www.​measuredhs.​com/​pubs/​pdf/​FR243/​FR%5B24June2011%5D.​pdf, http://​www.​measuredhs.​com/​pubs/​pdf/​FR243/​FR%5B24June2011%5D.​pdf, Zurück zum Zitat 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. Grand multiparity can also increase the risk of uterine rupture. Categorize intrapartum conditions that may result in complications for the newborn infant. 2005, Washington DC: ACOG and AAFP (ACOG), Report No. TOLAC (trial of labor after caesarean) in the context of grand multiparity is … Hindrance to appropriate distribution of healthcare resources to mothers and children include a lack of recent accurate data on the magnitude and factors that influence adverse maternal and neonatal outcomes. Edited by: Lawson JHK, Bergstrom S. 2003, London: Royal college of Obstetrics and Gynaecology, 20, Zurück zum Zitat Hughes PF, Morrison J: Grandmultiparity–not to be feared? 2. CrossRefPubMed, Zurück zum Zitat Bai J, Wong FW, Bauman A, Mohsin M: Parity and pregnancy outcomes. 2006, 6: 6-, Article  Predictors of adverse outcomes in relation to grand multiparous women were assessed at p = 0.05. PubMed  The first section was demographic characteristics such as age and parity. Myers SA, Gleicher N: A successful program to lower cesarean-section rates. CrossRefPubMed, Zurück zum Zitat Kyu HH, Shannon HS, Georgiades K, Boyle MH: Caesarean delivery and neonatal mortality rates in 46 low- and middle-income countries: a propensity-score matching and meta-analysis of demographic and health survey data. A total of 1025 multiparous women met the inclusion criteria and were assessed. Obstet Gynecol. 2002, 53 (1): 6-12. 1998, 25 (3): 529-538. 2002, 186 (2): 274-278. Aktuelle, verlässliche Information und Fortbildung für Ärzte im Berufsalltag. “Perinatal death” was defined as stillbirth of ≥28 weeks of gestation and early neonatal death. Primigravida constitutes 40% of cases whereas grand multiparas comprise 16–17% of all deliveries (MNH Obstetric Database, unpublished report). Aliyu MH, Salihu HM, Keith LG, Ehiri JE, Islam MA, Jolly PE: High parity and fetal morbidity outcomes. 2005, 105 (5 Pt 1): 1045-1051. 2013, 26 (13): 1325-1327. More recent reports select a … In general, the older literature defines “grand multiparity” (GM) as parity >7 [ 2 , 3 ]. Int J Epidemiol. CrossRefPubMed, Zurück zum Zitat Aziz-Karim S, Memon AM, Qadri N: Grandmultiparity: a continuing problem in developing countries. 2002, 19 (1): 1-8. 2002, 186 (2): 274-278. In general, the older literature defines “grand multiparity” (GM) as parity >7 [ 2, 3 ]. Lacerations of the genital tract. 2007, United States: Birth. Health Policy Plan. Clin Exp Obstet Gynecol. Open Access, 18.12.2020 | Infektionen in der Schwangerschaft | Podcast | Nachrichten, 16.12.2020 | EBM | Nachrichten | Onlineartikel. Privacy 2013, [cited 2013 3/23/12]. The principal investigator and two research assistants collected data throughout the day as recruitment proceeded. PubMed  Absence of risk related to GM has been reported in some studies [7–9] and partly supported in others [25–28], which related GM to poverty, social deprivation, late booking at antenatal clinics, and pre-existing chronic illnesses (including chronic hypertension and DM). Eur J Obstet Gynecol Reprod Biol. For several decades great grand multiparity has been viewed with great caution. All authors read and approved the final manuscript. 2013, 42 (3): 781-791. 2004, Geneva: WHO, Available from: http://www.who.int/whr/2004/annex/country/can/en/. 2006, 13 (2): 52-60. Kyu HH, Shannon HS, Georgiades K, Boyle MH: Caesarean delivery and neonatal mortality rates in 46 low- and middle-income countries: a propensity-score matching and meta-analysis of demographic and health survey data. • Grand multiparity • Malpresentation: unrecognised brow, face and shoulder presentation • Unrecognised cephalopelvic disproportion • Obstructed labour • Prostaglandin and oxytocin augmentation in women with high parity and previous caesarean section • Use ofhigh doses ofmisoprostol in parous women 4–7 The term … The age disparity between the two groups was managed by comparing the prevalence of important variables using age-adjusted ORs. Caution is required in translation of these institutional-study results based on outcome measures to the general population. The standard questionnaire had three sections. 2006, 13 (2): 52-60. Data collection was done for 6 months. Grand multiparity (delivery of ≥ 5 viable fetuses) Relaxant anesthetics. 01.12.2013 | Research article | Ausgabe 1/2013 The neonatal ward also admits sick babies from other nearby hospitals. Grand multiparity, defined as parity equal to or greater than 5 previous live births, 1–3 has been described as an independent risk factor for a variety of serious intrapartum complications, including placenta previa, placental abruption, malpresentation of the fetus, instrumented delivery, cesarean delivery, postpartum hemorrhage, prematurity, newborn intensive care unit admission, and maternal death. In Tanzania, guidelines set by the Maternal and Child Health section of the Ministry of Health and Social welfare consider GM to be an obstetric risk. 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). Poor perinatal outcomes include low birth weight, prematurity and perinatal mortality [20–23]. Our sincere appreciation goes to all the women who agreed to participate in this study, to the academic staff in the Department of Epidemiology and Biostatistics of MUHAS, Department of Obstetrics and Gynaecology of MUHAS, and all physicians and nurses in the Department of Obstetrics and Gynaecology of MNH who played an invaluable part in this study. Conversely, a high prevalence of GM has been reported in “developing” countries [10–12]. Data entry and cleaning was done by Epi Info™ ver6 and then transferred to SPSS ver13.0 (SPSS, Chicago, IL, USA) for statistical analyses. Goldman GA, Kaplan B, Neri A, Hecht-Resnick R, Harel L, Ovadia J: The grand multipara. Because of its cross-sectional design, the present study failed to make causal inferences of some risk factors (though it showed the prevalence of adverse pregnancy outcomes between grand multiparas and their lower-parity counterparts). CrossRefPubMed, Zurück zum Zitat Samueloff A, Schimmel MS, Eidelman AI: Grandmultiparity. J Obstet Gynaecol Res. Samueloff A, Schimmel MS, Eidelman AI: Grandmultiparity. CAS  N Engl J Med. Nassar AH, Fayyumy R, Saab W, Mehio G, Usta IM: Grandmultiparas in modern obstetrics. 2002, 109 (3): 249-253. 1994, 44 (3): 211-217. CrossRef, Zurück zum Zitat Toohey JS, Keegan KA, Morgan MA, Francis J, Task S, de Veciana M: The “dangerous multipara”: fact or fiction?. Obstet Gynecol. 1992, 38 (4): 281-286. Williams Obstetrics. However, other definitions are … The passage of meconium can be a physiological response of a mature gastrointestinal tract of the fetus or relaxation of the anal sphincter in response to fetal hypoxia. S Afr Med J. Dr. Andrew H. Mgaya MD, MMED; Specialist Obstetrician Gynecologist, Muhimbili National Hospital. Oxytocin is the main uterotonic agent used and is widely available in the labor ward. Prostaglandins such as misoprostol are used occasionally but acquired only from commercial pharmacies and not stocked in the hospital pharmacy. Agrawal S, Agarwal A, Das V: Impact of grandmultiparity on obstetric outcome in low resource setting. The mean rate of delivery per year is 9,000 deliveries with a daily rate of delivery of 10–30. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The mean birth weight was 3.003 ± 0.68 kg. Asia Oceania J Obstet Gynaecol. MNH provides basic and comprehensive emergency obstetric care. Retained placental tissues. Neonates delivered by grand multiparas were more closely associated with a low Apgar score (12.1%) compared with lower-parity women (5.4%) with an OR of 2.9 and a 95% CI of 1.5–5.0. 1985, 23 (4): 321-326. 2004, 103 (6): 1294-1299. 2004, 85 (3): 234-239. 1997, 87 (4): 456-459. Am J Obstet Gynecol. et al. There was a high prevalence of meconium-stained liquor, malpresentation and placenta previa in grand multiparas as compared with the lower-parity group, a finding that is in concurrence with other studies [4, 21, 45]. 1998, 25 (3): 529-538. CrossRefPubMed, Zurück zum Zitat Myers SA, Gleicher N: A successful program to lower cesarean-section rates. These data implied that, on average, a Tanzanian woman will bear 6 children [14]. The response rate was 100%. Professor Siriel N. Massawe MD, MMED, PhD; Consultant Obstetrician Gynecologist, Muhimbili University of Health and Allied Sciences. 2005, Washington DC: ACOG and AAFP (ACOG), Report No. : Contract No. PubMed  Grand multiparity and low birth weight were independently associated with a low Apgar score (OR, 2.4; 95%, CI 1.4–4.2 for GM; OR, 4.2; 95% CI, 2.3–7.8) for low birth weight. Mdegela M, Muganyizi P, Pembe A, Simba D, Van Roosmalen J: How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania?. 34, 65-79. Malays J Med Sci. The questionnaire was pretested for 3 days to assess flow of inquiry and the comprehensiveness of variables of interest, as well as to evaluate the consistency of the measurability of participants’ responses. We compared the maternal and perinatal complications among grand multiparous and other multiparous women in Dar es Salaam in Tanzania. Int J Gynaecol Obstet. 1991, 17 (4): 327-334. Williams Obstetrics. Babinszki A, Kerenyi T, Torok O, Grazi V, Lapinski RH, Berkowitz RL: Perinatal outcome in grand and great-grand multiparity: effects of parity on. 1985, 23 (4): 321-326. Cookies policy. HLK participated in data analyses and helped in the development of the final version of the manuscript. Women who did not consent to join the study were also excluded. 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. Great grand multipara have been reported to have an increased incidence in obstetric complications such as fetal malpresentation, placental abruption, … Some women come as self-referrals (especially those living near the hospital) and others come as private clients under Intramural Private Practise Management (IPPM). Williams Obstetrics. 1997, 87 (4): 456-459. Grand multipara describes the condition of having given birth five or more times. J Obstet Gynaecol. 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. 2011, 118 (1): 29-38. Grand multiparas had twice the likelihood of malpresentation and a threefold higher prevalence of meconium-stained liquor and placenta previa compared with lower-parity women even when adjusted for age. Odukogbe AA, Adewole IF, Ojengbede OA, Olayemi O, Fawole BO, Ahmed Y, et al: Grandmultiparity–trends and complications: a study in two hospital settings. The labor ward is managed by 5 nurse midwives and 2 attendants per shift. The term “grand multipara” was introduced in 1934 by Solomon, who called grand multiparas the “the dangerous multiparas” [1]. 2005, 91 (1): 89-96. 2005, Available from: https://​publications.​ki.​se/​xmlui/​bitstream/​handle/​10616/​39925/​thesis.​pdf?​sequence=​1, https://​publications.​ki.​se/​xmlui/​bitstream/​handle/​10616/​39925/​thesis.​pdf?​sequence=​1, Zurück zum Zitat Tanzania National Bureau of Statistics: Tanzania Demographic Health Survey Calverton. Int J Gynaecol Obstet. There are two obstetric operating theatres located adjacent to the maternity block and a private labor ward (IPPM Annex). The second section focused on obstetric risk factors such as hypertension and DM in the current pregnancy, previous preterm delivery, previous instrumental or CS, and a history of perinatal death. Source for information on grand multiparity: A Dictionary of Nursing dictionary. | springermedizin.de. Dr. Hussein L. Kidanto MD, MMED, PhD; Consultant Obstetrician Gynecologist, Muhimbili National Hospital and honorary Senior Lecturer, Muhimbili University of Health and Allied Sciences. CrossRefPubMed, Zurück zum Zitat Tai C, Urquhart R: Grandmultiparity in Malaysian women. PubMed, Zurück zum Zitat Ozkan ZS, Atilgan R, Goktolga G, Simsek M, Sapmaz E: Impact of grandmultiparity on perinatal outcomes in eastern region of Turkey. : 326. The third section recorded delivery outcomes and neonatal outcomes such as birth weight (g), prematurity (gestational age <37 weeks), congenital malformations, Apgar score and perinatal deaths. Predictors for adverse outcome in relation to grand multiparas were assessed using logistic regression analyses. Asia Oceania J Obstet Gynaecol. Edited by: Cunningham F e. 2005, United States of America: McGraw-Hil, 461-462. 2010, Maryland USA: IFC Micro, [cited 2013 8/8/2013]. 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. Table 3 displays neonatal outcomes according to parity. J Obstet Gynaecol Res. This state of deprivation leads to poor care of the newborn in the early or later neonatal period, thereby resulting in morbidity or mortality of the neonate [25], rather than the obstetric performance in the current pregnancy (which is more closely related to the health of the newborn). Obstetrics and Gynaecology specialty parameters and management protocols [Internet]. The prevalence of hypertension and DM in the current pregnancy was higher among grand multiparas but without significant differences when adjusted for age (p = 0.51, OR 1.6, 95% CI 0.3–9.8 and p = 0.06, OR 1.4, 95% CI 0.8–2.3, respectively). Int J Gynecol Obstet. The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Am J Perinatol. Diabetes Care. Correspondence to 2013, [cited 2013 3/23/12]. Article  2013, 26 (13): 1325-1327. CrossRefPubMed, Zurück zum Zitat Oladapo OT, Lamina MA, Fakoya TA: Maternal deaths in Sagamu in the new millennium: a facility-based retrospective. Cite this article. Roman H, Robillard PY, Verspyck E, Hulsey TC, Marpeau L, Barau G: Obstetric and neonatal outcomes in grand multiparity. In the present study, the prevalence of a history of intrauterine fetal death was comparable between the two groups. Hence, high parity is not considered to be a risk factor for pregnancy-related complications [7–9]. We found the prevalence of hypertension and DM in pregnancy to be comparable between the two groups when age was adjusted. PubMed Central  BJOG. 2006, 29 (11): 2349-2354. 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]. Grand multiparity increased the risk of uterine rupture in the presence of a scarred uterus (level of proof NP4) but there was no recommendation due to the small number of studies . Obstetrics and Gynaecology specialty parameters and management protocols [Internet]. 2001, 21 (4): 361-367. The expected least frequency of disease in the unexposed group was estimated to be 2.0%. 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]. Similar studies have reached the same conclusion [3, 7] but others [34–36] have found a significantly higher prevalence of hypertension and DM in grand multiparous women. Gynecol Obstet Invest. Conclusive evidence of fetal distress is more closely related to the characteristics of variability in the fetal heart rate and acidemia [47, 48]. Clin Perinatol. Multiple regression analyses revealed that malpresentation; meconium-stained liquor and placenta previa were three-times more likely in grand multiparas than lower-parity women even when adjusted for age (all p ≤ 0.05). The current medical literature contains studies of this non-FDA-approved indication for misoprostol. HNM contributed in the design of the study and participated in the development of the first and final version of the manuscript. Tai C, Urquhart R: Grandmultiparity in Malaysian women. CrossRefPubMed, Zurück zum Zitat Goldman GA, Kaplan B, Neri A, Hecht-Resnick R, Harel L, Ovadia J: The grand multipara. J Matern Fetal Neonatal Med. Is it a perinatal risk?. The obstetric wards are attended by 35 obstetricians working with 25 obstetrics and gynecology residents, 2 registrars and ≈25 nurse midwives. Bailey PE: The disappearing art of instrumental delivery: time to reverse the trend. The Doctors-on-call Team comprises 1 specialist, 2 obstetric residents and 1 intern physician on 24-h call. more years and grand multiparity. Despite a history of fetal or neonatal loss being a recurrent risk factor [4], grand multiparas in the present study showed a higher prevalence of a history of previous neonatal deaths rather than fetal and neonatal demise in the current pregnancy. More recent reports select a definition of GM to start from a parity of 5 because the threshold of risks of any obstetric complication, neonatal morbidity, and perinatal death increase markedly at parity ≥5 [ 4, 5 ]. A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk factors. Grand multiparas had twice the likelihood of malpresentation and a threefold higher prevalence of meconium-stained liquor and placenta previa compared with lower-parity women even when adjusted for age. 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. 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). 2006, Available from: http://www.nbs.go.tz/takwimu/references/2002popcensus.pdf, Mbaruku G: Enhancing survival of mothers and their newborns.