- Sara Ellis Simonsen, CNM, MSPH, PhD
Sara Ellis Simonsen, CNM, MSPH, PhD
- Visiting Instructor, Department of Family and Preventive Medicine
- Division of Public Health
- University of Utah Health Sciences Center
- Michael W Varner, MD
Michael W Varner, MD
- Professor, Maternal-Fetal Medicine
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
A 1934 study suggested that increasing parity increased the risk of pregnancy complications, and first introduced the term "grand multipara" . The author concluded that grand multiparity was dangerous because, in his study, maternal mortality increased steadily from the 5th to the 10th pregnancy. This topic will discuss issues related to grand multiparity.
A reasonable definition of grand multiparity is ≥5 live births and stillbirths ≥20 weeks of gestation, with great grand multiparity defined as ≥10 live births and stillbirths ≥20 weeks of gestation . However, other definitions are also used. (See 'Variability in the definition of parity' below.)
Pregnancy losses under 20 weeks of gestation are considered abortions. Abortions are not counted toward parity, but are counted toward gravidity (ie, the number of times a woman has been pregnant, including her current pregnancy).
In the United States in 2013, 2.8 percent of live births were the fifth child in the family, 1.5 percent were the sixth or seventh child, and 0.3 percent were the eighth child and over . Africa has the highest rate of grand multiparity .
FACTORS AFFECTING THE RELATIONSHIP BETWEEN PARITY AND PREGNANCY OUTCOME
The relationship between obstetric complications and parity has been studied extensively, with inconsistent findings. In addition to the usual limitations of observational data, there are several reasons for the discordancy:
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- FACTORS AFFECTING THE RELATIONSHIP BETWEEN PARITY AND PREGNANCY OUTCOME
- Variability in the definition of parity
- Variability in the definition of controls
- Nonlinear relationship between parity and pregnancy outcome
- Inadequate adjustment for maternal age
- Healthy person effect
- RISK OF PREGNANCY COMPLICATIONS
- Role of previous cesarean delivery
- LONG-TERM RISKS
- PATIENT COUNSELING
- PREGNANCY MANAGEMENT
- SUMMARY AND RECOMMENDATIONS