Antepartum and intrapartum complications in grandmultiparous patients compared with multiparous patients at Tygerberg Hospital
Objective. To examine whether grandmultiparous women in a modern setting with adequate health care are at greater risk of complications in the antepartum and intrapartum period than multiparous women. Patients and methods. The labour registry and hospital files were used and all grandmultiparas were identified from 31 December 2002 restrospectively for a period of 18 months with each grandmultiparous patient matched with a control patient selected by identifying the first multiparous patient to deliver within the same week. Results. No statistical difference was noted in antenatal maternal medical disorder such as chronic hypertensive disease in multiparas versus grandmultiparas (7/97 v. 6/101, 7.2% v. 5.8%) and diabetes mellitus. The development of pre-eclampsia was also not significantly different. Although the difference in pregnancy-induced hypertension (PIH) was not significant, with PIH in the multiparous group 22/97 (22.7%) and in the grandmultiparous group 12/101 (11.9%) (p-value = 0.04398, odds ratio 2.18, confidence interval: 0.95 - 5.03), a trend was observed for more multiparas to develop PIH. Conclusion. In the modern setting with adequate health care, properly trained nursing staff and doctors and well-designed protocols grandmultiparity is not associated with a significantly increased risk of the classic complications traditionally associated with it. We conclude that provided adequate health care exists, there should be no difference in the complications experienced by grandmultiparous and multiparous patients.