Grandmultiparity in Modern Obstetrics: A Retrospective Analysis of maternal and fetal outcome in a Tertiary Hospital, Gwalior

Background:Grandmultiparity has been associated with increased risks of adverse pregnancy outcomes. More recent literature has contradicted the earlier reports and showed that grandmultiparity does not entail significant maternal or neonatal risks in a modern obstetrical setting. This study aimed to estimate the proportion of grandmultiparous women admitted during the study period in our institute and to study the maternal and perinatal outcomes related to grandmultiparity.Methods:This is a retrospective cross sectional descriptive study conducted in the Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior (M.P.), during a period of 1 year from January 2019 to December 2019. The retrospective review of case records of all grandmultiparae admitted in labor ward during the study period was done. Analysis was done with the excel computer software and results were reported as percentage.Results:During the study period, total number of women delivered was 9977, out of which 159 were grand multipara with a prevalence of 1.5 %. Majority of women were in age group 31-35 years (62.26 %), were from rural areas (74.21 %), were referred (77.98 %) and had no antenatal visits (90.32 %). 116 (72.95 %) patients delivered vaginally, while 42 (26.41 %) patients were delivered by lower segment caesarean section. The main indication of caesarean section was placenta previa. Maternal complications noted were preterm delivery (12.57 %), premature rupture of membranes (5.66 %), malpresentation (12.02 %) and antepartum hemorrhage (6.9 %). Placenta previa was seen in 5.66 % women and 2 patients presented with placental abruption. Cesarean hysterectomy was done in one patient for placenta percreta. No case of atonic PPH was noted. In present study there was no maternal death reported among grand multipara. 136(85.53 %) babies were born alive, 17 (10.69 %) patients presented with intrauterine fetal death on admission. There were 6 perinatal deaths. 25.78 % newborns were born with low birth weight. Conclusions:Grandmultiparity is still an obstetric risk factor. Proper antenatal care, timely referral, properly timed caesarean section in selected cases would reduce the grandmultiparity associated adverse pregnancy outcomes