Definition of Grand Multiparity
Grand multiparity is defined as a woman who has delivered five or more times (≥5 previous deliveries), though some sources use a threshold of seven or more deliveries.
Standard Definition
The most commonly accepted definition in modern obstetric practice is a woman with five or more previous deliveries (parity ≥5), as evidenced by contemporary research examining outcomes in this population 1, 2.
An alternative threshold of seven or more deliveries has been used in some epidemiological studies and older literature, particularly in large-scale surveys 3.
The term specifically refers to the number of deliveries (births), not the number of pregnancies, distinguishing it from gravidity 1.
Clinical Significance and Risk Profile
Grand multiparity is associated with significantly increased maternal risks including a 2-fold increased risk of postpartum hemorrhage, gestational diabetes, hypertensive disorders, malpresentation, and preterm delivery 1, 2.
The risk of placental abruption is approximately 3-fold higher in grand multiparous women compared to multiparous women with 2-3 previous deliveries 2.
Perinatal mortality is nearly doubled and maternal mortality increased 10-fold in grand multiparous women compared to the general obstetric population 4.
Grand multiparous women have a 3-fold higher prevalence of meconium-stained liquor and placenta previa, with neonates at 3-times greater risk of low Apgar scores 5.
Important Clinical Context
Grand multiparity remains a high-risk obstetric condition in modern practice, particularly in low-resource settings where access to prenatal care may be limited 1, 4.
The association between grand multiparity and adverse outcomes is partially but not entirely explained by advanced maternal age, as the risks persist even when age-matched controls are used 2, 3.
Nearly one quarter of grand multiparous patients receive little or no antenatal care, which significantly compounds the risk of adverse outcomes including increased stillbirth rates 4.