title: The outcome of grand-multiparous pregnancies of Arabic and Jewish populations in peripheral and central areas of Israel.
abstract: OBJECTIVE
  To compare the antepartum and intrapartum course of Jewish and Arab great-grandmultiparas from central and peripheral areas in Israel to age-matched control multiparous women.
  
  
  METHODS
  Medical records of four groups of parturients were compared: great-grandmultiparas (para > or = 9) and multiparae (para 2-5) delivering at Nazareth E.M.M.S. hospital (mostly Arabs) and Hadassah-Ein-Kerem hospital in Jerusalem (mostly Jews). The control groups consisted of demographically and geographically matched multiparas. Data was collected on prenatal care received, antepartum complications, as well as the intrapartum complications traditionally associated with high parity (e.g. malpresentation, placental abnormalities, peripartum hemorrhage, shoulder dystocia). Neonatal records were also examined to determine any neonatal morbidity or mortality.
  
  
  RESULTS
  There were 139 and 141 great-grandmultiparas in the Nazareth and the Jerusalem study groups, respectively (mean parity was 10.1 and 10.9, respectively), and 142 and 139 multiparas in the Nazareth and the Jerusalem control groups, respectively (mean parity was 2.9 and 2.5, respectively). The rate of physician visits during the prenatal period in the Nazareth and the Jerusalem study groups was 2.3 +/- 2.4 and 3.2 +/- 2.7, respectively (p=0.0041). This rate was significantly higher in the controls of both areas (4.0 +/- 3.0 and 4.9 +/- 2.9, respectively). There was no difference in the rate of nurse visits in all groups in all areas. Maternal and neonatal outcomes were similar in both study groups, and were also similar in the control groups, but perinatal mortality was higher in both great-grandmultiparous groups compared to the controls (11/280 and 2/281, respectively; p<0.05).
  
  
  CONCLUSIONS
  The differences in the intensity of prenatal care between these rural and urban areas did not affect the maternal outcomes of great-grandmultiparous pregnancies. In addition, there were no significant differences in maternal outcomes between great-grandmultiparas and multiparas in rural and urban areas although prenatal care was less intense in the former. However, increased incidence of perinatal mortality in the great-grandmultiparas may be due to factors unrelated to prenatal care intensity or quality.
authors.affiliation: Department of Obstetrics, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Ezra
authors.forename: E
authors.initials: E
authors.lastname: Schmuel
authors.forename: M
authors.initials: M
authors.lastname: Hakim
authors.forename: J G
authors.initials: JG
authors.lastname: Schenker
mesh_terms: D000328:Adult; D018912:Arabs; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D007585:Jews; D008428:Maternal Mortality; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012424:Rural Population; D014505:Urban Population