title: Grandmultiparity: evaluating obstetric and neonatal outcomes after eliminating confounders.
abstract: OBJECTIVE
  The objective was to evaluate obstetric and neonatal outcomes in booked grandmultiparas (para e"5) and compare with outcome in age and social status matched booked multiparas (para 2-4) after eliminating confounders.
  
  
  METHODS
  A cohort study with grandmultiparas (subjects) and age and social status matched multiparas as controls. All participants were counseled and an informed consent obtained at the antenatal clinic. Maternal demography and history were taken; they were subsequently monitored during pregnancy, labour and immediate puerperium. The main outcome measures were obstetric and neonatal outcomes among subjects and controls.
  
  
  RESULTS
  The incidence of grandmultiparity was 4.1%. During antenatal period, grandmultiparas had statistically significantly higher occurrence of late antenatal booking (P=0.0202), anaemia (P=0.0024) and past history of poor perinatal outcome (P=0.0124). Grandmultiparas had statistically significant occurrence of preterm delivery (P=0.0389) and higher but not statistically significant mean duration of labour (P=0.3532), intrapartum complications (P=0.2014) and postpartum haemorrhage (P=0.2126). Neonates of grandmultiparas had statistically significant low first minute Apgar scores (P=0.0011) with higher but not statistically significant occurrence of low birth weight (P=0.1613) and neonatal intensive care admission (P=0.7202). The perinatal mortality rates were 136 and 75 per 1 000 deliveries for grandmultiparas and multiparas. There were no maternal deaths during the study period.
  
  
  CONCLUSIONS
  After controlling for age and social class, booked grandmultiparas had poorer obstetric and neonatal outcome compared to booked multiparas but these were majorly statistically insignificant due to effect of modern antenatal care.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ilorin /University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: A S
authors.initials: AS
authors.lastname: Adeniran
authors.forename: A A
authors.initials: AA
authors.lastname: Fawole
authors.forename: O O
authors.initials: OO
authors.lastname: Fakeye
authors.forename: M A
authors.initials: MA
authors.lastname: Ijaiya
authors.forename: K T
authors.initials: KT
authors.lastname: Adesina
mesh_terms: D000328:Adult; D000367:Age Factors; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005865:Gestational Age; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012923:Social Class