Friday 5 August 2016

CONCEPT OF OBSTETRIC RISKS OF HIGH PARITY

Primiparity, Multiparity, Grand multiparity, Great Grand Multiparity and Extreme Grand multiparity.
Parity, the number of deliveries by a woman after the gestational age of viability has been described using several terminologies which include Multiparity, primiparity, multiparity grand multiparity and great grand multiparityimplying increasing number of deliveries. These have sometimes been incorrectly applied by clinicians and midwives alike (Opara and Zaidi, 2007 in Umoh and Abah, 2012).
Parity also refers to the number of previous pregnancies of more than 24weeks and primiparity is the first pregnancy where as multiparity is the condition of being pregnant or giving birth more than once (Bai, Wong, Bauman, Mohsin, 2009). High parity has been variously defined in different literature. Some writers defined it as a woman with four or more parous experience while others considered it as six or more.

In the United Kingdom, parity refers to as the number of times that a woman has given birth to a foetus with gestational age of 24weeks or more, regardless of whether the child was born alive or was still born while gravity refers to as the number of times that a woman has been pregnant. 

In biology, the term “Gravid” is derived from Latin word “Gravidus” meaning “burdened, heavy”. It is used to describe the condition of animal (most commonly fish or reptiles) when carrying eggs internally while “parity” is the number of pregnancies carried to viable gestational age. 

In human medicine, “gravidity” refers to the number of times a woman has been pregnant regardless of whether the pregnancies were interrupted or resulted in a live birth. Thus, in biology and human medicine, gravidity and parity are two terms that refers to the number of times a female has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity) (Borton, Chloe, 2009). A multigravida refers to a woman who has been pregnant more than once while a multiparous woman (multip) refers to a woman who has given birth more than once. 

The definition of grand multiparity varies from study to study. Some authors (Saidman, Armon, Roll, Stevenson, Gale, 2008, Samuelofe, Mor-Yousef, Seidman, Rabinowiz, Simm, Schenker, 2011) have defined grand multiparous women to have seven children where as (Toohey, Keegan, Morgan, Francis, De, Veginia, 2007) have the definition of grand multiparity to be pregnancy greater or equal to five (≥5). Grand multipara can also be referred to as a woman who has already delivered five (5) or more infants who have achieved a gestational age of 24wks or more, and such women are traditionally considered to be at higher risk than the average in subsequent pregnancies, While a great grand multipara has delivered seven or more infant beyond 24wks of gestation.

According to Zaheera Saadia (2014) the term “grand-multipara” was introduced in 1934 by Solomon who called the grand multipara the “dangerous multipara”. In general, the older literature defines “grand multiparity” (GM) as parity greater than 7 (>7) (Andrew, Sirel, Hussein and Hans, 2013). Another literature selecteda definition of GM to start from parity of five (5) because the threshold of risk of any obstetric complication, neonatal morbidity, and perinatal death increases markedly at parity greater than or equal to five (≥5). A grand multipara is therefore, a woman who has already delivered five or more infants and who have achieved gestational age of 24weeks or more in each pregnancies. Such women are traditionally considered to be at higher risk than the average in subsequent pregnancies. A grand multigravida has been pregnant five times or more. A great grand multipara has delivered seven or more infants beyond 24 weeks gestation (Pratts, Schmittdiel, McLean, Ushar and Goldman, 2011). 

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