Outcome of pregnancy in the Grandmultipara in Enugu, Nigeria

Abstract

Context: Grandmultiparity is considered high-risk because of the associated maternal and fetal complications. Grandmultiparae constitute a significant proportion of the obstetric population in Nigeria hence the problems of grandmultiparity still abound. Objective: To describe the outcome of pregnancy in grandmultiparae. Design, Setting and Subjects: A retrospective study of the grandmultiparous patients delivered at the University of Nigeria Teaching Hospital, UNTH, Enugu, Nigeria, from 1 January 1998 to 31 December 2002. Main Outcome Measures: Data on the age, parity, booking status, literacy level, complications during pregnancy and labour, method of delivery, maternal and foetal outcome, were collected and analysed. Results: Of 3767 deliveries, 618 or 16.41% were grandmultiparous. Their mean age was 34.63 years and mean parity 5.77. 61.6% were illiterate and 83.82% were booked. Anaemia, hypertension and multiple pregnancies occurred in 18.29% in pregnancy. 17.95% had complications in labour. 74.3% achieved vaginal delivery. There was no maternal death. The perinatal mortality rate was 73.4/1000 deliveries. Conclusion: Grandmultiparae make up a significant proportion of our obstetric population. Illiteracy, desire for large families, high perinatal mortality and non-use of contraception are predisposing factors. Non-use of antenatal services and delay in referral worsen pregnancy outcome. Formal education, campaign against large families, reduction in childhood mortalities and improvement in use of family planning will reduce its incidence while use of hospital services will improve pregnancy outcome. Early referral, team work between health professionals and the roles of government, hospital management and non-governmental organizations are discussed. Keywords: grandmultiparity, pregnancy outcome, Enugu, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 8-11