The impact of grand multiparity on late pregnancy and early labour, hospital-based study on Garhwal region, Uttarakhand

Background: Grand multiparity has been associated with adverse outcome for both fetus and mother such as antepartum hemorrhage, malpresentation, caesarean section rate, postpartum hemorrhage, iron deficiency anemia, and a high perinatal mortality rate. This study aimed to estimate the proportion of the antenatal, intrapartum and perinatal complications outcomes related to grand multiparity. Methods: This is a prospective observational study conducted during a period of 1 year from 2021 to 2022 in the department of obstetrics and gynaecology, Himalayan hospital, Jollygrant, Dehra Dun, Uttarakhand. 60 grand multiparous patients who delivered during this period was analysed. Mothers with fetus/neonates were assessed for antenatal and obstetrical complications, mode of delivery and post-partum complications. Results: During the study period, majority of women were in age group 26-30 years (45%), from plain areas (60%), and hilly areas (40%), 85% patients delivered vaginally, while 15 patients delivered by lower segment caesarean section. The main indication of C section was previous 2 LSCS. Maternal complications noted were anemia (30%), preterm labour (23.3%), malpresentation (1.7%) and placenta previa was seen in 3.3% women. Atonic PPH was noted in 10% cases. In present study there was no maternal death reported among grand multipara. 61 babies were born, in which 1.6% neonates were still born. There were no perinatal deaths. 34.45% newborns were born with low birth weight. Conclusions: Grand-multiparity is an obstetric risk factor. Proper antenatal care, education, properly timed caesarean section in selected cases would reduce the grand-multiparity associated adverse pregnancy outcomes.