Maternal and fetal outcomes in grand multiparous women.

Grand multiparity is defined by the International Federation of Gynecology and Obstetrics (FIGO) as 5 deliveries or more [1]. Although the incidence of grand multiparity is low in economically developed countries, religious or cultural factors mean that it is common in some populations or communities. Several studies have provided data concerning the risk of grand multiparity for bothmother and fetus [1–5]. However, grandmultiparity does not necessarily lead to significant additional maternal, fetal, or neonatal complications in high-income countries where access to highquality healthcare is available [4]. The healthcare system in Croatia is socially oriented, especially for women and children, where 6-10 prenatal visits including 4 ultrasound examinations are common. Migration of people from eastern countries to Europe in the last 20years, for political and economic reasons, has had an influence on our community and we have observed an increased incidence of multiparous deliveries in our hospital. The aim of the present studywas to examine the influence of grandmultiparity on fetal and maternal outcomes at our institution. The studywasdesigned as a retrospective analysis ofmedical records taken from a tertiary healthcare center with approximately 3000 deliveries per year. During a 6-year period from 1993-1999 a total of 22 504womenwere delivered at the hospital. Onlymultiparouswomen with 3 or more previous deliveries were included in the study to obtain a similar populationand to eliminate confounding factors. Twogroupsof multiparous women were compared. Group 1 comprised grand multiparous women who had had 5 or more deliveries (n=107, 0.5%), whereas group 2 comprised multiparous women who had had 3-4 deliveries and who served as the control group (n=2745, 12.2%). The following parameters were assessed from the maternal records: age, marital status, education and employment as measures of socioeconomic status, number of prenatal visits, and pregnancy and labor complications. Fetal outcomes assessed were: birth weight, Apgar score at 1 and 5 minutes, acidosis, intracranial hemorrhage, early cerebral signs, infections, malformations, and mortality as measures of perinatal care. Statistical analysis was performed using the Fisher exact test and the t test was used to compare the two groups. Independent ethical committee approval was obtained for this study. Grandmultiparouswomenweremore likely to be older, unmarried or divorced, less educated, unemployed, and to have received less prenatal care than the control group; these differences were significant (Table 1). Although labor complications were similar between the two groups, the cesarean delivery rate was significantly higher in group 1 compared with group 2 (13.1% vs 8.2%; P=0.037). Mean duration of labor was similar between the two groups, but prolonged labor of more than 24 hours was more frequent in group 1. Mean birth weight was significantly lower for neonates born to grand multiparous women compared with multiparous women (3237±568 g vs 3424±621 g; P=0.000). Although the percentage of neonates born with a low birth