Monjurul Hoque - Medical Manager, Empangeni Hospital, KwaZulu-Natal, New Germany ۳۶۱۰, South Africa.
Ehsanul Hoque - Lecturer, Statistician, Mangosuthu University of Technology, Jacobs, ۴۰۲۶, South Africa.
Suriya B Kader - Hospital Manager,Wentworth Hospital, Private Bag JACOBS, ۴۰۲۶, South Africa.

Background: Intrapartam complications such as foetal malpresentation, placental abruption, dysfunctional labour, and postpartum haemorrhage are associated with grandmultiparity. In developing countries and many parts of Africa and sub-Saharan Africa, there is limited access to medical care. There is a need in these areas to identifywomen whose pregnancies are at risk of complication and it is an important part of antenatal screening and care during delivery to reduce adverse outcomes.Objective: The objectives of this study were to evaluate the complications duringpregnancy and delivery of grandmultiparity and to compare it with other parity groups. Materials and Methods: A retrospective case control study was conducted targetingwomen delivered at Empangeni Hospital during April to December 2004. Among all women who delivered at the hospital, 352 grandmultimaras, 3326 nulliparas and 3772who had parity 1 to 5, were taken as cases and controls respectively for the study. Results: Significantly higher rates of ante partum (1%) and post partum (2%) haemorrhages, post term delivery (3%), and intrauterine foetal deaths (4.5%) wereobserved in grandpultiparas compared to nulliparous women but there was no difference with parity group 1-5. Assisted vaginal delivery rates were significantly lower ingrandpultiparas women (2%) compared to nulliparous (5%) group (p < 0.05) but there was no difference with parity group 1-5. There were no significant differences inanaemia (14%), hypertension (10%), eclampsia (0.5%) and diabetes (3%), elective and emergency caesarean delivery (14.2%) and low-birth-weight delivery rates (13.2%)among different parity groups. Conclusion: Grandmultiparity was not safer compared to other lower parity groups.Thus strategies are needed to guide women to seek proper care during pregnancy and if possible to avoid pregnancy if they had higher parity.

Pregnancy outcome, Grandmultiparity, Pregnancy complications, Rural setting