Int J Gynecol Obstet 1985;23(4):321–6. Incidence The incidence has been gradually declining over the couple of decades due to acceptance about one-tenth of the hospital populations and accounts for 1/3 of the maternal death in the developing countries. PREGNANCY ASSESSMENT AND MANAGEMENT. grand multipara compared to 61.2% in control group. A grand … Great grand multipara have been reported to have an increased incidence in obstetric complications such as fetal malpresentation, placental abruption, dysfunctional labor and postpartum hemorrhage. Great grand multipara also have a higher incidence of macrosomia (12% vs. 12%) P < 0.0001. The incidence of grand multipara has decreased in most western countries in recent years due to better socioeconomic status and high use of contraception11,12,13. SCREENING AND ASSESSMENT Initial antenatal examination - in the first trimester of pregnancy. Grand multipara in relation to obstetric performance is labelled high risk. In third world countries like Pakistan the large families are still common. Methodology: All un-booked grand multipara with singleton pregnancy at term admitted to Gynae A Unit, Lady Reading Hospital Peshawar were included in the study. Contraindications a) In late pregnancy • Grand multipara • Contracted pelvis • History of LSCS or hysterectomy • Malpresentation b) During labour 1. [2] Juntunen K, Kirkinen P, Kauppila A. A review of 5785 cases. [3] Fuchs K, Peretz BA, Marcovici R, Paldi E, Timor-Tritsch I. A grand multipara is a woman who has already delivered five or more infants who have achieved a gestational age of 24 weeks or more, and such women are traditionally considered to be at higher risk than the average in subsequent pregnancies. ELSEVIER European Journal of Obstetrics & Gynecology and Reproductive Biology 61 (1995) 105-109 The grand multipara Gil A. Goldman*, Boris Kaplan, Alexander Neri, Rivka Hecht-Resnick, Linda Harel, Jardena Ovadia Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, P. O.Box 65171. Objective: To find out the effect of grand multiparity on maternal outcome in absence of adequate antenatal care. The clinical outcome in pregnancies of grand grand multiparous women. High risk pregnancy is defined as one in which the mother, fetus or newborn are at increased risk of morbidity or mortality before, at or after birth [2] . Having a heterogenous population, the problem of Grand Multiparity still exists in our country. HIGH RISK. Obstructed labour 2. This study is based on 5785 cases of GM which were treated in our Obstetrical Department during a period of 16 years (1960 – 1975). High Risk Pregnancy. Cross sectional study was carried out from 1st June 2012 to 1st Dec 2012. Acta Obstet Gynecol Scand 1997;76(8):755–9. 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