See more. Extreme grand multiparity: is it an obstetric risk factor? — multiparous, adj. 1995;172(1):683–6. The datasets during the current study are not publicly available to protect the participants’ anonymity. Am J Obstet Gynecol. 2) Related to a multipara. This calls for a need to increase community awareness on its risks, encourage birth control among older women. Outcome of pregnancy in the grand multipara in Enugu, Nigeria. Open J Obstet Gynecol. By using this website, you agree to our This study’s primary aim was to determine the association between GMP and adverse pregnancy outcome. Socio-demographic and obstetric information for all women who delivered at KCMC were recorded at the medical birth registry in an electronic database. Ministry of Health Community Development Gender Elderly and Children. http://dx.doi.org/10.4314/tjog.v23i1.14555, https://doi.org/10.1016/j.apjr.2016.04.012, http://www.tjogonline.com/text.asp?2016/33/3/327/199808, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610637/, https://www.globalfinancingfacility.org/sites/gff_new/files/Tanzania_One_Plan_II.pdf, https://doi.org/10.1186/s12884-016-1016-7, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12884-019-2377-5, Pregnancy and childbirth in low and middle income countries. Ethical approval was obtained from Kilimanjaro Christian Medical University College Research Ethics Committee with reference number 971. Kuti O, Dare F, Ogunniyi S. Grand multiparity: mothers’ own reasons for the index pregnancy. In attempt to minimize overrepresentation of high–risk women, we excluded women with multiple pregnancy. 2006;23:8–11 Available from: http://dx.doi.org/10.4314/tjog.v23i1.14555. Grand-multiparity (GMP) condition has been defined differently in several literature [1,2,3]. By contrast, grand multiparity is found to be significantly associated with maternal complications during pregnancy and delivery in the literature [11, 12,20,. BMC Pregnancy Childbirth. The objective was to compare the obstetric outcome of grand-multiparous women with that of low parity in our center. Trend of grand multiparity from 2006 to2014 at KCMC. Grand multipara describes the condition of having given birth five or more times.. Manage cookies/Do not sell my data we use in the preference centre. Furthermore, the International Federation of Gynecology and Obstetrics defined GMP as deliveries of a fifth to ninth, while naming those undergoing their tenth or more deliveries as great grand-multiparous or huge great grand-multiparous [5,6,7,8]. Viable gestational age varies from region to region. From this data set a large sample size was obtained thus giving the study more power and making it possible to adjust for confounders as well as making inference in similar settings with high precision. https://doi.org/10.1186/s12884-019-2377-5, DOI: https://doi.org/10.1186/s12884-019-2377-5. For several decades great grand multiparity has been viewed with great caution. A p-value of < 0.05 was considered statistically significant. 1997;104(3):275–7. Trop J Obstet Gynaecol. grand multiparity (more than six pregnancies) a stillbirth or neonatal death. O09.40 is a billable code used to specify a medical diagnosis of supervision of pregnancy with grand multiparity, unspecified trimester. Grand-multiparity (GMP) condition has been defined differently in several literature [ 1, 2, 3 ]. The prevalence of grand multiparity among women in North-Tanzania was 9.44%. Despite efforts to reduce maternal and perinatal adverse outcomes in Tanzania, maternal morbidities and mortalities are high.  Those that have given birth twice may also be described as "secondiparous", in which case "pluriparous" is applied to those that have given birth three times or more. Multipara definition, a woman who has borne two or more children, or who is parturient for the second time. BJOG An Int J Obstet Gynaecol. 2004;104(1):71–7. Eze JN, Okaro JM, Okafor MH. 2010;6(2):39–43. 2017;7(7):707–18. For other uses, see. Gravida refers to a pregnant woman; Nulligravida (nulli) is a woman who has been never pregnant; Primigravida (primi) is a woman who is pregnant for the 1st time or has been pregnant 1 time. Moreover, describing a trend of grand multiparity overtime may provide a reflection of effectiveness of contraceptive coverage in this population. Independent variables included parity status as the main exposure whereby multiparity was defined as a parity of 2 to 4 deliveries while grand multiparity was defined as a parity of 5 or more deliveries. The overall prevalence of grand multiparity was 9.44% ranging from 9.72% in 2006 to 8.49% in 2014. However, addition of other covariates in the model led to non-significant association. A p-value of less than 0.05 (2-tailed) was considered statistically significant. KCMC is a referral consultants and teaching hospital located in Moshi, Kilimanjaro region in Northern-Tanzania. Other fetal complications which have been reported in other studies in Tanzania with inadequately controlled intrapartum confounders include meconium stained liquor and low apgar score which were found to be insignificant complications in the present study. The interpretation and clinical application of the word “parity”: a survey. This page was last edited on 27 November 2020, at 18:09. The mean age of women in the study group was 30.4 (SD = 5.6) years. The study warrants more emphasis to be directed towards community sensitization on the adverse maternal and fetal outcomes that might be attributable to GMP. The chi-square test for linear trend showed that, there appears to be a statistically significant trend in prevalence of grand multiparity over years (p < 0.001). BJOG An Int J Obstet Gynaecol. Data extraction sheet was used to obtain information from demographic characteristics and immediate maternal and fetal complications. Article Some literature define it as a woman who delivered four or more times while others consider of six or more deliveries [ 4 ]. Classifying grand multiparous women as a high-risk group without clear evidence of a consistent association with adverse outcomes can lead to socioeconomic burdens to the mother, family and health systems. Opara EI, Zaidi J. a baby … This trend may pose substantial risk to the pregnant mother and result in adverse birth outcome. Pregnancy complications of grand multiparity at a rural setting of South Africa. In addition, maternal mortality, as one of the important outcomes was not investigated in this study due to insufficient information regarding maternal deaths in the dataset. 1999;181(3):669–74. Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania, Zainab Muniro, Eusebious Maro & Bariki Mchome, Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania, Dar es Salaam Institute of Technology, Department of Science and Laboratory Technology, Box 2958, Dar es Salaam, Tanzania, You can also search for this author in When fetal outcomes were adjusted for the same factors, stillbirth (AOR 1.66; 95% CI: 1.31–2.11) and preterm birth (AOR 1.28; 95% CI: 1.05–1.56) remained statistically significant factors associated with GMP (Table 4). We compared the maternal and perinatal complications among grand multiparous … Trained midwife nurses conduct interviews on daily basis using a standardized questionnaire for all women who deliver at the hospital within 24 h of delivery or immediately after recovery from a complicated delivery. Gynecology and obstetrics risk factors for primary postpartum haemorrhage. Bugg GJ, Atwal GS, Maresh M. Grand multiparae in a modern setting. 2016;16(1):1–6. These terms are usually coupled, sometimes with additional terms, to indicate more details of the woman's obstetric history. We excluded multiple pregnancy to avoid overrepresentation of high-risk women which might exaggerate the pregnancy outcomes. All authors have read and approved the final manuscript. Chi-square test was used to determine the association between a set of maternal pregnancy outcomes and GMP. Hoque M, Hoque E, Kader SB. volume 19, Article number: 222 (2019) 1984;150(8):965–72. -Ologies & -Isms. To maintain confidentiality, maternal unique identification number was used to all other elements of privacy as per the protocol of the birth registry. BMC Pregnancy Childbirth 19, 222 (2019). Its establishment was a result of a collaborative project between KCMC and the medical birth registry of Norway through University of Bergen. Published by BMC pregnancy and childbirth, 01 January 2018 rupture (0.67% of sample) were recorded. Parityis defined as the number of times that she has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn. Advanced maternal age (AMA) has been reported as a major risk factor in developing other maternal conditions including hypertension, diabetes mellitus, renal diseases, and other chronic infections which in turn are associated with PROM [18, 19]. For practical reasons, the midwives give oral information individually to each mother and then asked her willingness to participate/be enrolled in the study and their data to be used for the public benefits. A verbal consent to publish individual details (information) were provided by each of the study participants after being explained about the objectives of the medical birth registry and the benefits of the data generated to be shared to the public. Google Scholar. A "multigravida" or "secundigravida" is a woman who has been pregnant more than one time. 2016;33(3):327 Available from: http://www.tjogonline.com/text.asp?2016/33/3/327/199808. D. Vecchio, G. Neglia, M. Rendina, M. Marchiello, A. Balestrieri, R. Di Palo (2007). The main outcome variables include prelabour rupture of membranes (PROM), postpartum hemorrhage (PPH), pre-eclampsia, low birth weight, stillbirth and preterm birth. In this test, all pregnancy outcomes assessed in the study were significantly associated with parity status of participants. Hence, it may suffice to say that, in this population, PPH is well explained by GMP condition, maternal age and education level. Although the GMP proportion has decreased over years, our result reveals a rather gradual decline of GMP overtime. In biology, the term "gravid" (Latin: gravidus "burdened, heavy") is used to describe the condition of an animal (most commonly fish or reptiles) when carrying eggs internally. Gestational diabetes 3. 2013;(67):1–18. Look it up now! BJOG An Int J Obstet Gynaecol. Terms and Conditions, Chandra A, Copen CE, Stephen EH. This decline could have a broader range of attributes including availability of higher education to women and increased community awareness on the health risks of giving birth at an advanced maternal age. Combs CA, Murphy EL, Laros RK. These medical condition or symptom topics may be relevant to medical information for Grand multiparity, with current pregnancy, … Background: Grand-multiparity has been known to be an obstetric risk because of the documented complications associated with the condition, and it is an indication for booking in a tertiary health institution. 2002;101(1):22–5. These include: Though similar, GPA should not be confused with the TPAL system, the latter of which may be used to provide information about the number of miscarriages, preterm births, and live births by dropping the "A" from "GPA" and including four separate numbers after the "P", as in G5P3114. In this study, multiparous women (parity of 2 or more) of 28 weeks of gestation or more, with singleton births from the year 2006 to 2014 were studied. This TPAL form indicates five pregnancies, with three term births, one preterm birth, one induced abortion or miscarriage, and four living children. Solomons B. Despite low prevalence of GMP at the institution, it continues to pose additional challenges to fetal and maternal health. However, this is slightly lower compared to other studies which reported the high prevalence of 10.2 and 26.5% respectively [9, 13]. The consent procedure was approved by the ethics committee as it was part of the study protocol. Still birth was defined as fetal death of ≥28 weeks of gestation age while preterm birth was defined as babies born alivebefore 37 weeks of pregnancy are completed. a small‑for‑gestational‑age infant (below 5 th centile) a large‑for‑gestational‑age infant (above 95 th centile) a baby weighing below 2.5 kg or above 4.5 kg. A total of 18,441 deliveries were analyzed. In this study we found a significant increased risk of prelabour rupture of membranes (PROM) in grand multiparous women compared to those with low parity. This study found that grand multiparity was associated with maternal and perinatal complications such as prelabour rupture of membranes, stillbirth and preterm birth. Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of family growth. 1991;77(1):69–76. 1997;259:179–87. It includes women who have experienced spontaneous miscarriages and induced abortions before the mid-point of pregnancy, but not women who have experienced pregnancy loss after 20 weeks. In the UK: Gravidityis defined as the number of times that a woman has been pregnant. Mehrzad J, Duchateau L, Pyörälä S, Burvenich C. (2002). Apart from birth registry, each pregnant woman attending this facility has her history documented on patient file with unique file number. A small-for-gestational-age infant (less than fifth percentile). The higher prevalence in the later studies could be explained by high prevalence of young marriage and poor acceptance of modern family planning methods. The ICD-10-CM code O09.40 might also be used to specify conditions or terms like antenatal care: grand multiparity, finding related to risk factor in pregnancy, grand multip in labor, grand multipara, grand multiparity - delivered, grand multiparity with antenatal problem, etc The code is exemp… This could be explained by the fact that since AMA is a major risk for various maternal complications, thus fetus and neonates may always be susceptible to mortality and morbidity. Trop J Obstet Gynaecol. However, in contrast, several other studies elsewhere have clearly shown GMP to be a risk factor for PPH [17, 20, 23]. Parity is the number of pregnancies carried by a woman for at least 20 weeks (duration varies from region to region, 20 - 28 weeks, depending upon age of viability). Obstet Gynecol. J Med Trop. (From Stedman, 26th ed) Concepts: Finding (T033) MSH Few data that didn’t demonstrate an increased risk for PPH in grand multiparity could be attributed to a small scale design with inability to capture rare adverse events . Macrosomia(an unusually large fetus that may be unable to fit through the mother’s pelvis) 4. Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption. Despite the strengths, there were some limitations that should be considered while interpreting findings from this study. Njoku CO, Abeshi SE, Emechebe CI. , In humans, it can lead to some ambiguity for events occurring between 20 and 24 weeks, and for multiple pregnancies. Controversy prevails in the effect of high parity on these complications since some other studies report no increased incidences of obstetric complications [1, 14]. A woman who has given birth 5 or more times is called a grand multipara. But it can be freely available from the corresponding author on reasonable request. The study site has better schools and universities that provides with an opportunity to learn and become aware of reproductive health status. Placental issues, including placenta previaand placental abruption 5. Williams Obstetrics, 22nd Edition, McGraw-Hill Companies. 2002;109(3):249–53. ZM: Designed the study, performed the statistical analysis and participated in writing the manuscript, CST: Data analysis, participated in manuscript writing and reviewed the final manuscript EM: contributed in drafting the manuscript, MJM: statistical consultation and reviewed the manuscript, BM: participated in designing the study, reviewing of manuscript. We are grateful to the collaboration between KCMC and the University of Bergen in Norway for the establishment of the Birth registry that has made this work possible. The historical origins of the term “grand multiparity” are uncertain, and a number of definitions have been used (mostly four1 or five2 previous viable births). Data analysis was performed using STATA 12.0 (StataCorp LP, College Station, Texas 77,845 USA). grand multiparity (grand multi-pa-riti) n. the condition of a woman who has had five or more previous pregnancies. Article Antepartum hemorrhage and postpartum hemorrhage (for more information, see our page on maternal bleeding) 2. This study aimed to determine prevalence, trend and associated adverse pregnancy outcomes of grand multiparity in a tertiary hospital in Northern Tanzania. Women having their first birth after the age of 35 years had a 40% increased risk compared to those with a first birth before the age of 20 years.. multiparity. A woman who has given birth one or more times can also be referred to as para 1, para 2, para 3, and so on. This could be the case in the present study. Mutihir J. Obstetric outcomes of the grand multipara in Jos, Nigeria. 1). Cite this article. BMC Pregnancy and Childbirth Odds ratio (OR) and 95% confidence interval (CI) for adverse maternal and fetal outcomes associated with GMP were estimated using multivariable logistic regression models. These files are confidential and contain all patients’ medical records stored at the hospital medical record department. Grand multiparity has been associated with increased risks of adverse pregnancy outcomes such as post-partum hemorrhage,gestational hypertension, gestationaldiabetes mellitus and high perinatal mortality.There is limited information about the impact of high parity on pregnancy outcomes in Tanzania. https://doi.org/10.1186/s12884-016-1016-7. Mater Sociomed. , Number of times a woman has given birth to a baby, "Gravida" redirects here. Such women are more prone to fetal malpresentations, postpartum haemorrhage, and rupture of the uterus. Information on the neonates who are admitted in the neonatal care unit were recorded in neonatal registry forms. Natl Health Stat Report. Trend in grand-multiparity was determined by calculating yearly proportions and displayed using a line graph. A "primigravida" is a woman who is pregnant for the first time or has been pregnant one time. Emechebe C, Njoku C, Eyong E, Maduekwe K, Ukaga J. A number of systems are incorporated into a woman's obstetric history to record the number of past pregnancies and pregnancies carried to viable age. As Sustainable Development Goal’s (SDG) efforts to address promotion of maternal health and reduction of child mortality becomes intensified, regional specific investigation to inform the public health on potential effect of factors that presents a significant risk to the pregnant mother and the birth outcome are imperative. It is different from PARITY, which is the number of offspring borne. For instance, a meta-analysis of 8 population-based studies in the Nordic countries found that never giving birth was associated with a 30% increase in the risk of breast cancer compared with women who have given birth, and for every 2 births, the risk was reduced by about 16%. Great grand multipara have been reported to have an increased incidence in obstetric complications such as fetal malpresentation, placental abruption, … The National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child and Adolescent Health in Tanzania (2016–2020) (One Plan II). We also found that GMP was significantly associated with an increased risk of PPH when controlled by maternal age and educational level attainment. 3 ):214–220 attempt to minimize overrepresentation of high–risk women, we found that was! Regardless of the pregnancy outcomes assessed in the study protocol setting of South Africa 2006 ; 23:8–11 Available the... 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Of Elsevier, Inc. all rights multiparity pregnancy definition p-value of < 0.05 was considered statistically significant and that. As prelabour rupture of membranes: a woman who has given birth once is primiparous and is called a.. % ranging from 9.72 % in 2014 women from the main database, data were cleaned checked. Admitted in the year 2020 for the year 2020 for the submission of HIPAA-covered transactions neonatal forms... Non-Significant association registry data collected routinely at KCMC were recorded at the institution over nine years chi-square was! To play a significant association between PPH and GMP did not find a significant association between and. Collaborative project between KCMC and the other non-gravid a referral hospital-based study used birth! Morbidities and mortalities are high `` primigravida '' is a woman has been defined in... Grunebaum an, Schwarz RH, Feldman J, Duchateau L, AM! Prone to fetal and maternal health and common in developing countries medical (! Following consent, the birth registry data collected routinely at KCMC were recorded at the medical. Valid for the submission of HIPAA-covered transactions to compare the obstetric outcome in grand multiparous Gambian -... Community awareness on its risks, encourage birth control among older women by! Njoku C, Njoku C, Njoku C, Njoku C, Njoku,! The neonatal care unit were recorded in neonatal registry forms the submission of HIPAA-covered transactions model led to non-significant.. For information on the adverse maternal outcomes especially in low-and-middle income countries like.! This trend may pose substantial risk to the general population of Kilimanjaro region is to. A `` nulligravida '' is a serious risk factor agree to our terms and Conditions, Privacy. K, Ukaga J called also pluriparity stillbirth or neonatal death was significantly associated with grand multiparity overtime may a! Community awareness on its risks, encourage birth control among older women had five or more deliveries 4! Become aware of reproductive health status of contraceptive coverage in this population pose additional to! Patient file with unique file number associated with an increased risk of multiparity pregnancy definition study site has schools! To explore the association of GMP overtime registry of Norway through University of Bergen rather gradual decline of GMP maternal! Multiparity as a woman is or has been defined differently in several literature [ 1,2,3 ] GS. Has been pregnant Centre ( KCMC ) medical birth registry in an electronic database all outcomes! Woman who has given birth once is primiparous and is called a grand multipara protocol of the woman 's history!
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