Grand Multipara or Multiparity: Causes, Management and Complications

Grand Multiparity or Multipara Definition:

The term “‘multipara” applies to any woman who has given birth 2 or more times. A woman who has given birth 5 or more times is called a grand multipara. Grand multipara relates to a pregnant mother who has got previous four or more viable births.

Grand multipara or multiparity
Fig: Grand multipara or multiparity

Few studies or research concluded that grand multiparity is a huge risk for many fetal and maternal complications including abnormal placentation, malpresentation, abruption placenta, and interventional delivery, and postpartum hemorrhage, prematurity, and neonatal and maternal admission to intensive care unit (ICU) admission.

Causes of Grand Multiparity or Multipara:

Grand multipara causes includes-

  • Low socio-economic status,
  • Illiteracy,
  • Lack of reproductive knowledge,
  • Unmet need tor contraception,
  • Desire for son,
  • Too early marriage,
  • Poverty.

Complications of Grand Multiparity or Multipara:

A. During pregnancy:

1. Abortion,

2. Prematurity,

3. Obstetric hazards:

  • Malpresentation,
  • Multiple pregnancy,
  • Placenta praevia.

4. Medical disorders:

  • Anaemia – iron deficiency,
  • Hypertension,
  • Pre-eclampsia,
  • Cardiac isability,
  • Exaggerated manifestations of haemorrhoids, hiatus herniae & varicose vein.

B. During labour:

  • Cord prolapse,
  • Cephalo-pelvic disproportion,
  • Obstructed labour,
  • Rupture uterus,
  • Postpartum haemorrhage,
  • Shock,
  • Increase operative interference,
  • Shoulder dystocia,
  • Inversion uterus.

C. During puerperium:

  • Sub-involution of uterus,
  • Failing lactation,
  • Increased morbidity,
  • Wound infection,
  • Deep vein thrombosis.

D. Others

  • Ill health,
  • Increased MMR,
  • Prone to develop genital prolapse.

Management of Grand Multiparity or Multipara:

1. Adequate antenatal care:

  • Frequent antenatal visit.
  • Mandatory hospital admission during delivery.
  • Good antenatal care is essential and these patients must be booked for hospital delivery.
  • A good diet with high protein and low carbohydrate.
  • Iron and folic acid supplement should be given.

2. During labour:

  • Presentation & position are to be checked.
  • Malpresentation must be sought and treated appropriately.
  • Pelvic assessment should be done routinely.
  • Oxytocics must be used with caution during labor: only the intravenous route is used, starting with a small dose.
  • Giving i.v. Ergometrine with the birth of anterior shoulder will reduce the risk of PPH.
  • The possibility of disproportion must not be overlooked.

3. During puerperium:

  • As usual,
  • Family planning.

4. Family planning advice:

  • Advice not to conceive again.
  • If agree than permanent sterilization can be advised and done.
  • Other appropriate measures for appropriate family planning.

More questions related to this article:

  • What is grand multiparity?
  • What is the meaning of grand multiparity or grand multipara?
  • What do you mean by grand multipara?
  • What are the main causes of grand multipara?
  • Write down the complications of grand multipara.
  • Write down the management of grand multipara.
  • What is the management of grand multiparity?
  • Describe the management of Grand multipara.

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