title: Labor in the grand multipara.
abstract: OBJECTIVE
  To assess delivery time and the frequency of dystocia in grand multiparous (GMP) and grand grand multiparous (GGMP) women.
  
  
  METHODS
  Labor records from 272 women with parity 4-8 (GMP) and 56 women with parity 9 or higher (GGMP) were retrospectively reviewed regarding duration of labor and the occurrence of dystocia. As a comparison, data from 263 women with parity 1-3 (LMP) and 87 nulliparas (NP) was used.
  
  
  RESULTS
  Duration of labor, defined as time from admission of the laboring woman to delivery of the infant, lasted in median 2.0, 2.3 and 3.1 h in LMP, GMP and GGMP, respectively. There was no difference in mean cervical dilatation on admission in multiparous women. In GGMP, the presenting part was more frequently positioned above the pelvic inlet at time of admission. In multiparous women admitted during the latent phase, the active phase of labor lasted in median 3.7 h in GMP and 4.7 h in GGMP, significantly longer than 2.9 h in LMP. During the active phase of labor, GGMP experienced arrest of cervical dilatation more frequently than the LMP. In parous women, there was a positive relationship between parity and duration of the active phase of labor as well as the duration of labor. Infant's birth weight increased by parity.
  
  
  CONCLUSIONS
  Duration of the active phase of labor increased after the fourth child. Failure of descent of the presenting part during the first stage of labor in addition to arrest of cervical dilatation was associated with a high cesarean section rate in the GMP woman.
authors.affiliation: Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, University Hospital, Uppsala, Sweden. Sven.Lyrenas@kk.uas.lil.se
authors.forename: Sven
authors.initials: S
authors.lastname: Lyrenäs
mesh_terms: D004420:Dystocia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors