Rayamajhi R, Thapa M, Pande S
Department of Obstetrics and Gynaecology, Kathmandu Medical College, Sinamangal, Nepal.
Kathmandu Univ Med J (KUMJ). 2006 Jan-Mar;4(1):70-4.
Traditionally grandmultiparity has been considered to be an obstetric hazard both to the mother and foetus. Compounding factors are low socioeconomic status, poor female literacy and social deprivation. In developed populations with improved and optimal obstetric services, parity per se is no longer considered a significant risk for adverse obstetric and perinatal outcome.
To compare the obstetric and perinatal outcome between grandmultiparas and second gravidas with previous one delivery as well as analyse certain socio demographic features in the two groups.
Case records from Maternity Hospital, Kathmandu, an inner city tertiary care centre were retrospectively studied. 106 cases of grandmultiparous patients were compared with 110 cases of second gravidas who had previously delivered once which was taken as the control group. Biosocial features as well as obstetric and perinatal outcome were analyzed.
Rural residents comprised 60.4% of the grandmultiparous group versus 27.7% of the control group. A predominance of early marriage as well as an older age profile was noted in the grandmultipara. ANC attendance was documented to be much lower among grandmultipara with 26.4% having absolutely no antenatal care. A higher frequency of hypertensive disorders in pregnancy, preterm birth, anaemia, malpresentations, multiple pregnancy and premature rupture of membranes, postpartum haemorrhage and retained placenta was noted in the grandmultipara which also had a slightly higher caesarean delivery rate. The salient adverse perinatal outcome was found to be intrauterine foetal death, preterm birth and neonatal sepsis.
In our set up, grandmultiparity continues to challenge our obstetric practice with its associated increased likelihood of maternal and perinatal complications. Concerted effort should be directed to reducing high parity in the community through effective family planning initiatives and specialized antepartum and intrapartum supervision of this group should be available.
传统上，多产一直被认为对母亲和胎儿都是一种产科风险。复合因素包括社会经济地位低、女性识字率低和社会剥夺。在产科服务得到改善和优化的发达人群中，产次本身不再被认为是不良产科和围产期结局的重大风险。
比较多产妇与有过一次分娩史的二胎孕妇的产科和围产期结局，并分析两组的某些社会人口学特征。
对加德满都一家市中心三级护理中心——妇产医院的病例记录进行回顾性研究。将106例多产妇患者与110例有过一次分娩史的二胎孕妇进行比较，后者作为对照组。分析生物社会特征以及产科和围产期结局。
多产妇组中农村居民占60.4%，而对照组为27.7%。多产妇中早婚以及年龄较大的情况更为普遍。多产妇的产前检查率低得多，26.4%的人完全没有接受过产前护理。多产妇中妊娠期高血压疾病、早产、贫血、胎位异常、多胎妊娠和胎膜早破、产后出血和胎盘残留的发生率较高，剖宫产率也略高。围产期的主要不良结局是胎儿宫内死亡、早产和新生儿败血症。
在我们的研究中，多产仍然给我们的产科实践带来挑战，因为其相关的孕产妇和围产期并发症的可能性增加。应通过有效的计划生育举措共同努力降低社区中的高生育次数，并且应为这一群体提供专门的产前和产时监督。
