Obstetric problems in the grand multipara: a clinical study of 1330 cases

From January 1982-December 1986, researchers reviewed 1130 patients who had 7 or more viable pregnancies at the University Teaching Hospital in Al-Khobar, Saudi Arabia. The majority of the patients (90%) received regular prenatal care and most of the remaining patients attended a prenatal clinic 3-4 times. For the grand multipara, the rate of spontaneous abortion was higher (24%) compared to total deliveries (13%) in that hospital during the study period. Anemia was the leading predelivery complication for the study group (16.6% vs. 3.5% for total deliveries). Preeclampsia followed as the 2nd leading complication (6.1% vs. 5.2% for total deliveries). In 1 case a 45 year old gravida 13 had eclampsia, and both mother and infant survived. Antepartum hemorrhage occurred in 5.8% of the multiparous women (2.3% for total deliveries) due to abruptio placentae in 43 patients and placenta previa in 34 others. 5.6% of the multiparous patients (1.2% for total deliveries) experienced unstable lie, while successful induction of labor at term occurred in 60% of these women. Diabetes mellitus caused the least predelivery complications (4.8% vs. 2.8%). 73.3% of all deliveries to grand multiparous women resulted in normal deliveries. Delivery complications were higher for the study group, however, than for total deliveries: breech deliveries, 7% vs. 2.7%; premature labor, 7.5% vs. 2.7; cesarean section, 11.4% vs. 8.9%; and postpartum hemorrhage. 6.5% vs. 3.1%. The perinatal mortality rate of 62/1000 for the grand multiparous women was 3 times the overall rate for the hospital (21/1000). Stillbirt accounted for 50% of perinatal deaths for the remaining deliveries. 1 maternal death occurred among the grand multigravida.