title: Peripartum complications in grand multiparous women: para 6-9 versus para > or =10.
abstract: OBJECTIVE
  To assess the importance of birth order and advanced maternal age on maternal and peripartum complications.
  
  
  METHODS
  The study population consisted of 12 296 multiparous women (six deliveries or more) with singleton gestation. Patients were classified into two groups according to the birth order: grand multiparous (between six and nine deliveries) and huge multiparous (ten or more deliveries). Peripartum complication was defined when at least one of the following conditions occurred: massive hemorrhage, uterine rupture, abruptio placentae, dysfunctional labor or malpresentations. Logistic regression analysis was used to evaluate the relationship between birth order and maternal age and peripartum complications.
  
  
  RESULTS
  Among the study population, 9587 (78%) were grand multiparous and the remaining 2709 were huge multiparous women. The rate of peripartum complications was higher in huge multiparous than in grand multiparous women: malpresentation (6.2% versus 5%, P<.005), massive hemorrhage (0.7% versus 0.4%, P<.001) and dysfunctional labor (6.4% versus 3.5%, P<.001). Huge multiparous women also had a higher rate of the following complications than grand multiparous women: cesarean section (14.4% versus 10.4%, P<.01), chronic hypertension (7.9% versus 3%, P<.001), severe pregnancy induced hypertension (2.6% versus 1.1%, P<.01), diabetes class A (10.7% versus 7.5%, P<.005), diabetes class B-R (4.3% versus 2%, P<.01) congenital anomalies (3.3% versus 2.6%, P<.05) and large for gestational age infant, (17% versus 12.4%, P<.01). When adjusted for maternal age, high birth order remained strongly associated with the occurrence of peripartum complications.
  
  
  CONCLUSIONS
  Huge multiparity was associated with a higher rate of maternal and peripartum complications than grand multiparity. Higher birth order remained an independent risk factor for peripartum complications after adjustment for maternal age.
authors.affiliation: Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Maymon
authors.forename: F
authors.initials: F
authors.lastname: Ghezzi
authors.forename: I
authors.initials: I
authors.lastname: Shoham-Vardi
authors.forename: R
authors.initials: R
authors.lastname: Hershkowitz
authors.forename: M
authors.initials: M
authors.lastname: Franchi
authors.forename: M
authors.initials: M
authors.lastname: Katz
authors.forename: M
authors.initials: M
authors.lastname: Mazor
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D001722:Birth Order; D001724:Birth Weight; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007231:Infant, Newborn; D007746:Labor Presentation; D016015:Logistic Models; D008423:Maternal Age; D007744:Obstetric Labor Complications; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D014597:Uterine Rupture / Q000453:epidemiology