Grand Multiparity – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
The term “multipara” applies to any woman who has given birth 2 or more times. A woman who
has given birth 5 or more times is called a grand multipara.
Or
Grand multipara relates to a pregnant mother who has got previous four or more viable births.
Grand multipara causes
1. Low socio-economic status
2. Illiteracy
3. Lack of reproductive knowledge
4. Unmet need for contraception
5. Desire for son
6. Too early marriage
7. poverty
Complications of grand multiparity:
A. During pregnancy:
➤ Abortion
➤ Obstetric hazards:
✔ Malpresentation.
✔Multiple pregnancy.
✔ Placenta praevia.
➤ Medical disorders:
✔ Anaemia-iron deficiency
✔ Pre-eclampsia.
✔Cardiac disability.
✔Exaggerated manifestations of haemorrhoids, hiatus herniae & varicose vein.
➤ Prematurity.
B. During labour:
➤ Cord prolapse.
➤ Cephalo-pelvic disproportionis t
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➤ Rupture uterus.
➤ Postpartum haemorrhage.
➤ Shock.
➤ Increase operative interference
➤Shoulder dystocia
➤ Inversion uterus
C. During puerperium
➤ Sub-involution of uterus
➤ Failing lactation.
➤ Increased morbidity
➤ Deep vein thrombosis.
D. Others
➤ Ill health
➤ Increased MMR
➤ Prone to develop genital prolapse.
Management of Grand multipara
A. Adequate antenatal care
➤ Frequrnt antenatal visit.
➤ Mandatory hospital admission during delivery.
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➤ Good antenatal care is essential and these patient must be booked for hospital delivery.
➤ A good diet with high protein and low carbohydrate. Iron and folic acid supplement should be given.
B. During labour:
➤ Presentation & position are to be checked.
➤ Malpresentation must be sought and treated appropriately.
➤ Pelvic assessment should be done routinely
➤ Oxytocics must be used with cautionduring labor: only the intravenous route is used, starting with a small dose.
➤ Giving i.v. Ergometrine with the birth of anterior shoulder will reduce the risk of PPH.
➤ The possibility of disproportion must not be overlooked
C. During puerperium:
➤ As usual
➤ family planning
D. Family planning advice:
➤ Advice not to conceive again.
➤ If agree than permanent sterilization can be advised and done
➤Other appropriate measures for appropriate family planning,
(Definition + Causes + Complication + Management)
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