Grandmultiparity: pregnancy outcome at Muhimbili national hospital in Dar-es-salaam, Tanzania

Abstract

Background: The association of grandmultiparity and poor pregnancy outcome has been controversial for decades. Limited access to medical care, mostly in developing countries, has led to a need of early identification of women whose pregnancies are at increased risk of poor outcome so as to allocate the few resources to the people who greatly need them. Classifying grandmultiparas women as high risk group without a clear evidence of consistent association of grandmultiparity with adverse pregnancy outcomes leads to an unnecessary financial, physical and psychological stress to the mother and the family. Also it unnecessarily increases the cost burden to health system. Objectives: This study sought to compare the obstetric and perinatal complications among grand multiparas and other multiparous women delivered at MNH. Material and methods: This was a cross sectional comparative study done at Muhimbili National hospital (MNH) which is the largest tertiary hospital and a University teaching Hospital in Dar es Salaam, the biggest city in Tanzania. Data collection was done in a period of 5 months (August 2007 through to December 2007). Women were identified after delivery from the delivery register, postnatal ward admission book and report books in the general ward. Participants enrolled in the study were assessed and asked questions according to the variables of interest indicated in the standard questionnaire. The level of statistical significant deference was when P value was less than 0.05. Potential confounder such age was controlled in some of the outcome variables and obstetric risk factor by using logistic regression analysis. Results: There was a significant association of grandmultiparity with a few adverse outcomes compared with the lower parity multiparas women. These adverse effects when the risk was adjusted for age included malpresentation (odds ratio [OR] 2.1, 95% Confidence interval [CI] 1.1-4.9), Placenta previa (OR 2.8; 95% CI 1.1-7.1), meconium stained liquor (OR 2.8, 95% CI 1.3-5.8), low Apgar score (OR 2.9; 95% CI 1.5-5.0), history of preterm delivery (OR 5.3; 95% CI 3.1 - 8.9) and history of neonatal deaths (OR 3.6; 95% CI 2.1 - 6.2). Grand multiparity was more associated with relatively higher socio economic status (P<O.05), less formal education (P<O.OOI), later booking at antenatal clinic (P<O.Ol) more contraceptive use (P<O.Ol), less planned pregnancies (P<O.Ol) and a tendency of having children with different spouses (P<O.Ol) Conclusion: This study suggests that grandmultiparity IS associated with significant adverse outcomes than lower parity women. Recommendations: There is a need for a bigger and more comprehensive community based study with sufficient number of cases for comparison of all pregnancy outcome variables of interest in order to be able to search for clear evidence of presence or absence of increased risk of adverse pregnancy outcomes in grandmultiparity compared to the lower parity women. There should be provision of adequate antenatal care and prompt implementation of the elements of the basic and comprehensive obstetric emergency care as designed by WHO in all relevant setting This is to reduce maternal morbidity and mortality across all parities by prompt risk assessment, health promotion, complication preparedness, birth readiness and appropriate care.