EFFECT OF GRAND MULTIPARITY ON OBSTETRIC AND NEONATAL OUTCOME IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

BACKGROUND: Grand multiparas are women who have carried five or more previous
pregnancies to viability i.e. para ≥5. Previous research results have suggested that grand
multiparas are at a much higher risk during pregnancy, delivery and postpartum.
However, recent studies are suggesting that this is not essentially so if corrections are
made for confounding factors like age and socioeconomic status.
OBJECTIVE: To determine the effect of grand multiparity on obstetric and neonatal
outcomes at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.
METHODS: This study is a prospective cohort study that compares obstetric and
neonatal outcome in grand multiparas (para ≥5) with that of age and social class matched
multiparous (para 2-4) controls at UITH Ilorin over a six months period from 1st February
to 31st July 2010.
RESULTS: The incidence of grand multiparity was 4.1% with mean age
36.20±4.23years; 30.3% of them were illiterates while 66.7% belong to social class 4
and 5. The commonest reason for index pregnancy was desire to have more children in
both groups (33.3% v 81.8%; p 0.001). Also, grand multiparas have significantly higher
cases of previous perinatal complications than controls (43.9% v 21.2%; p 0.005).
Grand multiparas booked for antenatal care late compared to multiparas [1st trimester- 0%
v 18.2%; >20weeks- 74.25% v 48.5%, p 0.0024]. In addition, they were significantly
more anaemic at booking compared to controls (43.09% v 21.2%; p-0.002); more grand
multiparas were obese at booking (40.9% v 19.7%; p 0.4292), and they have higher
occurrence of chronic hypertension [7.6% v 1.5%, p 0.2102] , and pre gestational diabetes
[1.5% v 0%] . More grand multiparas were diagnosed of gestational diabetes [12.2% v
4.5%, p 0.1154].
Grand multiparas had higher incidence of and preterm delivery (25.0% v 10.8%; p
0.0222) but occurrence of post term pregnancy was the same [3.1%] . Anaemia in labour
was commoner in grand multiparas [20.3% v 4.6%; p 0.0012), as well as abnormality in
the appearance of liquor in labour (50.0% v 35.4%; p 0.0582). They also had higher
incidence of intrapartum complications (57.8% v 43.2%; p 0.4729). Spontaneous vaginal
delivery occurred in 60.9% of grand multiparas compared with 67.6% in controls;
however, the rate of emergency caesarean section was the same (20%) in both groups.
Postpartum haemorrhage was commoner in grand multiparas (28.1% v 18.4%; p 0.2126).
Also, they had more low birth weight babies (21.8% v12.3%) and their babies had
significantly lower first minute Apgar scores and higher rate of admission into neonatal
intensive care (NICU) compared to controls. The perinatal mortality rate in grand
multiparas was 136 per 1000 while that of controls was 75 per 1000. There were no
maternal deaths during the study period.
CONCLUSION: Despite controlling for age and social class, booked grand multiparas
still had poorer obstetric and neonatal outcomes compared to booked multiparous
controls. Chronic medical disorders which were commoner in them may have contributed
to these. Grand multiparas had higher complications at booking dut antenatal care helped
in controlling them; thus, they should be encouraged to book early for antenatal care and
better still have pre conception care.

EFFECT OF GRAND MULTIPARITY ON OBSTETRIC AND NEONATAL OUTCOME IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN