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  • Title: Hazards of grand multiparity.
    Author: Vehaskari A, Lahtinen J, Terho J.
    Journal: Ann Chir Gynaecol Fenn; 1968; 57(4):476-84. PubMed ID: 5306154.
    Abstract:
    The authors report the special obstetric characteristics of grand multiparas (GMs) and the extent to which the parturient's age affected the incidence of complications. 8 deliveries were chosen as the minimum of deliveries for classifying parturients as GMs in this study. In a series of 1567 deliveries over 10 years in the same hospital in Oulu, Finland, differences were noted between the obstetric behavior of GMs as compared with other parturients. Hypertensive disease was distinctly more frequent among GMs than among the other parturients (p0.001). The frequency of abruptio placentae, placenta previa, and retained placenta was also significantly higher in GMs. Although the difference was not statistically clear in this study, the incidence of uterine rapture has been reported to be higher in GMs than in other parturients. Unlike the majority of reports, this study showed breach presentation to be less frequent among GMs. The incidence of operative deliveries was roughly similar in both groups. Caesarean section, including repeat sections, was distinctly lower among GMs (p0.01). The maternal mortality rate of GMs in the series was significantly (p0.01) higher than that of the other parturients (.12%). The primary causes of death were abruptio placentae (0.19%), rupture of the uterus (0.12%), and eclampsia (0.06%); a state of shock was a feature common to all the fatalities. No difference appeared in the incidence of multiple pregnancy, nor in the incidence of prematurity. The difference in number of stillbirths was not statistically demonstrable between GMs (3.71%) and other parturients (2.68%). The incidence of hypertensive disease was definitely correlated to age, whereas high parity played a small part. Abruptio placenta is affected both by high parity and age; placenta previa is independent of age and predisposed by high parity. Under careful supervision and proper treatment, the GM, despite the higher risk of complications, does not run a greater risk of mortality than other parturients.
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