title: The challenge of grandmultiparity in obstetric practice.
abstract: BACKGROUND
  Traditionally grandmultiparity has been considered to be an obstetric hazard both to the mother and foetus. Compounding factors are low socioeconomic status, poor female literacy and social deprivation. In developed populations with improved and optimal obstetric services, parity per se is no longer considered a significant risk for adverse obstetric and perinatal outcome.
  
  
  OBJECTIVE
  To compare the obstetric and perinatal outcome between grandmultiparas and second gravidas with previous one delivery as well as analyse certain socio demographic features in the two groups.
  
  
  METHODS
  Case records from Maternity Hospital, Kathmandu, an inner city tertiary care centre were retrospectively studied. 106 cases of grandmultiparous patients were compared with 110 cases of second gravidas who had previously delivered once which was taken as the control group. Biosocial features as well as obstetric and perinatal outcome were analyzed.
  
  
  RESULTS
  Rural residents comprised 60.4% of the grandmultiparous group versus 27.7% of the control group. A predominance of early marriage as well as an older age profile was noted in the grandmultipara. ANC attendance was documented to be much lower among grandmultipara with 26.4% having absolutely no antenatal care. A higher frequency of hypertensive disorders in pregnancy, preterm birth, anaemia, malpresentations, multiple pregnancy and premature rupture of membranes, postpartum haemorrhage and retained placenta was noted in the grandmultipara which also had a slightly higher caesarean delivery rate. The salient adverse perinatal outcome was found to be intrauterine foetal death, preterm birth and neonatal sepsis.
  
  
  CONCLUSIONS
  In our set up, grandmultiparity continues to challenge our obstetric practice with its associated increased likelihood of maternal and perinatal complications. Concerted effort should be directed to reducing high parity in the community through effective family planning initiatives and specialized antepartum and intrapartum supervision of this group should be available.
authors.affiliation: Department of Obstetrics and Gynaecology, Kathmandu Medical College, Sinamangal, Nepal. roshantr@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Rayamajhi
authors.forename: M
authors.initials: M
authors.lastname: Thapa
authors.forename: S
authors.initials: S
authors.lastname: Pande
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D008393:Marriage; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012424:Rural Population