A grand multipara is defined as a woman who has had four or more previous viable births. Such women face increased risks during pregnancy, labor, and the postpartum period, including abortion, malpresentation, prematurity, cord prolapse, obstructed labor, rupture of the uterus, and postpartum hemorrhage. Due to these complications, grand multiparas have a higher rate of maternal mortality in developing countries. As high-risk patients, grand multiparas require close antenatal monitoring and hospital delivery to watch for issues like abnormal fetal positioning, slow labor progression, and postpartum bleeding.

1. GRAND MULTIPARA
Prepared by-
JOISY S JOY
Lecturer
Mai Khadija Institute of Nursing Sciences, Jodhpur.

2. Definition
A grand multipara relates to a pregnant mother who has got previous
mother who has got previous four or more viable births.

3. 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.

4. Complications
Pregnancy
 Abortion
 Inherent obstetric hazards like;
• Malpresentation
• Multiple pregnancy
• Placenta praevia
 Medical disorders such as anaemia hypertension, haemorrhoids and
varicose veins etc.
 Prematurity

5. Labour
 Cord prolapse
 Cephalopelvic disorders
 Obstructed labour
 Rupture uterus
 Post partum haemorrhage
 Shock
 Operative interference because of complications

6. Puerperium
 Increased morbidity due to intranatal hazards
 Sub involution
 Failing lactation

7. Management
The cases are considered as ‘high risk’ as such they require adequate
antenatal care and should have a mandatory hospital delivery. During, the
following guidelines are prescribed.
 Pelvic assessment should be done as a routine.
 Presentations and positions are to be checked
 Undue delay in progress should be viewed with concern.
 To remain vigilant against PPH.

8. THANK YOU