|| Checking for direct PDF access through Ovid
The aim of this study was to perform a systematic review on the maternal and fetal/neonatal outcome of grand multiparity (defined as a woman giving birth for the fifth to ninth time) and on the outcome of great grand multiparity (women delivering for the tenth or following time).A Medline (1966-2004) and Google Scholar search was performed. Studies reporting on grand multiparity or great-grand multiparity and comparing these women with a control group were retained.On the subject of grand multiparity 19 comparative studies could be identified, of these 9 used para 5 to 9 as the definition of grand multiparity. Grand multiparous women show more obesity, gestational diabetes and chronic hypertension but less pre-eclampsia). Grand multiparous women more frequently have a suboptimal prenatal care. Concerning labour and delivery grand multiparous women have less malpresentation, induction, oxytocin use, caesarean section and instrumental delivery although they more often give birth to a macrosomic child. Grand multiparous women demonstrate more placenta previa and postpartum haemorrhage. Considering fetal and neonatal complications the risk of a low Apgar-score after 5 min. is higher, perinatal death is less frequent. No significant differences were found for maternal anaemia, breech position, meconium stained amniotic fluid, placental abruption or retention and fetal or neonatal death.Four articles on great grand multiparity were included. A significant increase was found for diabetes, hypertension, breech presentation, meconium stained amniotic fluid, caesarean section and macrosomia. Significant decreases were found for anaemia, prematurity, induction of labour and instrumental delivery. No significant differences were demonstrated for postmaturity, placenta previa, abruptio placentae, fetal distress, postpartum haemorrhage, low birthweight and congenital malformations.Grand multiparous women have higher rates of suboptimal prenatal care and are to be considered high risk obstetric patients. Data on great grand multiparous women are relatively scarce, problems seem to be related to macrosomia and non-cephalic presentation resulting in a higher caesarean section rate.