Study of caesarean section in grande multiparity

Introduction: 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. Aim: to study importance of ANC, complications and indications of caesarean section in grand multi’s and to investigate fetomaternal outcomes. Materials and methods: This is retrospective study conducted over a period of 2-yearsfrom august 2012 to June 2014. A total of 3640 deliveries were performed during 2 years, of these 858 were grand multiparas observed.100 multiparas who has undergone caesarean section were studied. Maternal and fetal variables assessed carefully. Informed consent was taken. Results: 100 cases of grande multiparas delivered by caesarean - section were analyzed. The incidence of caesarean section in grande multiparas in present study is 11.5%. 39% of cases were in 29-33 years age group and 28% were 34-38 years old. 90% cases were illiterate with only 4% having7th standard educational status. 79% were unbooked. 86% were of low socioeconomic status. 32% were gravida - 6, 20% were gravida -7, and 18% were gravida-5. The commonest indications for caesarean section were: APH - 28% of cases, Obstructed labour, Mal presentation and position - 24% of cases, Fetopelvic disproportion - 20% of cases, Fetal indications (distress) - 12% of cases, Soft tissue dystocia - 5% of cases, Multiple - indications - 11 % of cases. In 97% of cases caesarean section was done as an emergency procedure. Sub-umbilical midline incision was taken in all cases. In 93% lower segment caesarean section was done and in 6% required inverted T incision and classical in 1 case. The acceptance of sterilization was 79%.PNMR was 21.56% due to intrapartum sepsis, obstructed labour and APH ( 2 2 / 1000 births).MMR was 1 %, cause was due to septicemia and anemia. Conclusion: This study concluded that, in comparison to other patients, grande multiparas run a greater risk during pregnancy and labour. This risk can be effectively reduced with good ANC but still they are liable to serious complications of pregnancy which can lead to higher MMR and PNMR