Grand multiparity: obstetric performance in Aminu Kano Teaching Hospital, Kano, Nigeria.

OBJECTIVE The objective was to review the obstetric performance of booked grand multiparae. DESIGN AND SETTING A 5-year prospective observational study of cases between January 1, 2002, and December 31, 2006, was conducted in Aminu Kano Teaching Hospital, a tertiary institution, in Kano, Nigeria. MATERIALS AND METHODS The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery), who delivered in our labor ward, were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. OUTCOME MEASURES These were obstetric factors of maternal age and parity, antepartum hemorrhage, fetal malpresentations, and multiple pregnancy. Medical complications were gestational diabetes, hypertension, anemia, and heart disease. Pregnancy outcomes measured were gestational age at delivery, birth weight, mode of delivery, postpartum hemorrhage, and maternal and perinatal mortality. RESULTS The age range of the grand multiparae was between 22 and 43 years, with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15, with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55, CI = 6.72-23.91), hypertension (OR = 3.07, CI = 2.07-4.59), heart disease (OR = 2.01, CI = 0.70-6.08), anemia (OR = 3.16, CI = 1.42-7.24), antepartum hemorrhage (OR = 2.18, CI = 1.22-3.92), fetal malpresentations (OR = 3.04, CI = 2.38-3.88), cephalopelvic disproportion (OR = 2.09, CI = 1.33-3.29), and fetal macrosomia (OR = 2.27, CI = 1.72-3.00) among the grand multiparae compared with multiparae. CONCLUSION The effects of these complications were minimized by good antenatal care.