grandmultiparity has been considered an independent factor for increasing adverse outcome for both fetus and mother specially diabetes mellitus , antepartum hemorrhage , malpresentation , cesarean section rate , postpartum hemorrhage , iron deficiency anemia , and a high perinatal mortality rate al jf . more recent reports , however , have demonstrated that in the presence of good perinatal care , grand multiparity no longer need to be considered an obstetrical risk in the presence of satisfactory health care conditions . the majority of the studies argued that grandmultiparas are more likely to be of old age which might be the reasons for increased morbidity and mortality . in our clinical practice , such factor is difficult to be removed because women s age is the most important biological variable that influences the reproductive events which we study . in saudi arabia , large family is desirable for cultural reasons ; consequently , a high incidence of grand multiparity is expected . the fertility rate in saudi arabia was last reported at 2.81 in 2010 , according to a world bank report published in2012 . in addition , early age of marriage might be one of the reasons for this high incidence of grandmultiparas . the current study was conducted in a tertiary hospital where medical care is given free of charge for all mothers . the aims of the current study were to determine the prevalence and to investigate the fetomaternal outcomes related to grandmultiparity . in this retrospective study , the data were gathered from patient s case notes over a period of a 1-year from january 1 , 2012 through december 31 , 2012 at the maternity and children hospital ( mch ) , buraidah , saudi arabia in an attempt to determine the prevalence of grandmultiparity and its associated risks . uncomplicated cases received antenatal care at the level of primary health care centers , whereas complicated and referred cases are managed at the hospital . all deliveries took place in the hospital , and no home confinements were allowed . in this study , a grandmutliparas woman was defined as a woman who gave birth to 5 and more deliveries after 24 weeks gestations . a total of 8040 deliveries was performed during the year , of these 430 were grandmultiparas which were the actual number of grandmultiparity during the whole year . they were matched to 657 multiparas ( parity 1 - 4 ) women who delivered during the same time scale . sociodemographic factors , obstetric complications , and neonatal morbidity for both groups were recorded from the case note . maternal variables we assessed included diabetes mellitus , hypertensive disorders of pregnancy , premature rupture membrane , placental abruption , placenta previa , medical problems ( such as asthma , epilepsy and hypothyroidism ) , postpartum hemorrhage , tears , cesarean hysterectomy , preterm labor , mode of delivery and post term labor(diabetes was assessed separately because it is important variable for pregnancy outcomes ) . each of these variables was analyzed against each group . for clarity , medical problems included ( asthma , epilepsy and hypothyroidism ) and diabetes included both pre - existing and gestational diabetes fetal variables we assessed were admission to nursery , small for gestational age , fetal death , apgar score , fetal weight , gestational age at delivery , fetal distress and macrosomia . this study was approved by the ethics committee of the college of medicine of qassim university . the statistical package for the social sciences ( spss 17 for windows ) the descriptive statistics used included the mean , the frequency distribution and the standard deviation . a chi - square test was used to compare the means of qualitative data , whereas a student s t - test was used to compare the means of quantitative data . in multivariate analysis the results of the analysis are presented as odds ratio ( or ) and 95% confidant interval ( 95% ci ) . the total number of deliveries during the study period was 8040 , of these 430 were grandmultiparas . of 430 , grandmutiparas , 28.6% ( 123 ) were below 35 years of age ( younger grandmultiparas ) , in this group the csr was 27.2% ( 72 ) . there was no significant differences in the cs rate when they were compared with those above 35 years of age 72.8 % ( 307 ) p=0.666 as show in table 1 . values were presented as number ( percentage ) table 2 shows the frequency of the individual parity and the associated percentage . values are presented as number ( percentage ) in this study , the distribution of age according to parity showed a linear relationship with good agreement with p - p plot distribution . there were significant differences in maternal age ( 28.88285.26145 vs. 36.84884.40522 ; p<0.001 ) , number of previous abortions ( .3181.60298 vs. .82791.05916 ; p<.001 ) , gestational age at delivery ( 38.45561.75031 vs. 38.06952.00399 ; p=0.001 ) and the number of parity ( 2.29071.22442 vs. 6.33491.52353 ; p<0.001 ) between the study and the control groups . chi - square test was used to explore the differences in the antenatal complication between the multiparas and the grandmultiparas women . for clarity , medical disorders reported include ( bronchial asthma which constituted the majority , hypothyroidism and epilepsy ) . as listed in table 3 , grandmultipara women had a higher frequency for medical disorders ( p=009 ) , but both groups did not differ significantly in other antenatal obstetrics complications ( p>0.05 ) . values are presented as number ( percentage ) chi - square test and fisher s exact test ( cell count less than 5 ) were used to examine the differences between some post partum obstetrical complications between mulitparas and grandmultiparas . grandmultiparas when compared to multiparous women they were at an increased risk of cesarean delivery ( p<.001 ) . on the other hand , multiparous women compared to grandmulitparas were more likely to deliver by ventose ( p=0.0062 ) . other postpartum complications did not differ significantly between the two groups ( p>0.05 ) , table 4 . values are presented as number ( percentage ) binary logistic regression was used to explore the association of some selected antenatal and postnatal variables between multiparas and grandmultiparas as presented in table 5 . grandmultiparas were significantly associated with increased incidence of cesarean section ( or=2.699 , ci=2.072 - 3.515 , p<0.001 ) , macrosomic babies ( or=1.675 ; 95% ci=1.004 - 2.796 , p=.048 ) , diabetes mellitus ( or=1.634 , 95%ci=1.076 - 2.481 , .021 ) and pih ( or=1.838 , 95% ci=1.054 - 3.204 , p=.032 ) . logistic regression analyses demonstrated that grandmultiparas were not significantly associated with increased risk of hypertensive disorders , prom , preterm delivery , iufd , abruption , postpartum hemorrhage and iugr . odds ratio and 95% confidence interval for grandmultiparity and some selected pregnancy outcomes . 1 * reference category . the incidence of grandmutiparity in the current study was 5.3 % . due to the lack of consensus on the definition of grandmultiparity , previous regional studies from saudi arabia have documented different incidence of grandmultiparity [ 1 , 6 ] . the low prevalence rate of grandmutiparity in this study can be explained by the high acceptance of family planning . jabbar et al . in their study , which included 2675 saudi women attending a gynecology out- patient , demonstrated that 56.0% of women were using some form of contraceptive . of the 430 grandmultiparas in this study , 123(28.6 ) were less 35 years of age , which indicate early age of marriage leading to the concept of  younger grandmultiparity  and which may constitute additional risk for further complications . there was no significant difference in the rate of cs between grandmutiparity age less than 35 years compared to those greater than 35 years of age ( 60.0% vs. 62.3%l p= 0.666 ) . in the current study , we found that there was a significant association between grandmultiparity and adverse pregnancy outcomes ( such as cesarean delivery , fetal macrosomia , diabetes mellitus and pregnancy induced hypertension ) . these findings contradict with previous findings , [ 10 , 11 , 12 , 13 ] which concluded that grandmutiparity is not associated with increased risk for adverse pregnancy outcomes . certainly , our data support previous published findings [ 14 , 15 , 16 , 17 ] which stated that grandmutiparity continue to constitute potential risks for adverse pregnancy outcomes even after controlling for confounders . the high rate of cs among grandmutliparas women in this study can be explained by high frequency of fetal macrosomia , diabetes mellitus and pregnancy induced hypertension ( p<0.05 ) . all of these complications of pregnancy are well documented to increase the rate of cesarean delivery . this data showed , that within grandmultiparity , 120(27.9% ) of grandmultiparas were less than 35 years of age , of whom 72(60% ) were delivered by cs with no significant differences compared to those greater than 35 years of age , ( p=0.666 ) . this indicates that , this group of women started their reproduction before pelvic maturity and consequently resulted in high rate of cs due to feto - pelvic disproportion . while the high rate of cs among old grandmutiparas , may be due to secondary contracted pelvic as a result of repeated compensatory lordosis of pregnancy this study revealed that there was no significant association between grandmultiparity and placenta abruption , placenta previa , preterm labor , postpartum hemorrhage and babies admission to the intensive care unit ( icu ) , p>0.05 . nassar and colleagues observed no significant differences in antepartum hemorrhage , intrauterine growth restriction and stillbirth rates [ 8 , 19 ] . however , rayamajhi et al . , reported stronger association of hypertensive disorders in pregnancy , preterm birth , anemia , postpartum hemorrhage in the grandmulmultiparity . in his study , 3 ( .7% ) cases of grandmultiparity underwent hysterectomies , one for complete placenta previa and two for uncontrolled postpartum hemorrhage , giving a hospital incidence of one in 2680 deliveries , a comparable incidence of one in 2581 was reported from tunisia . , there was no significant association between grandmultipara and admission to icu , intrauterine fetal death and low birth weight babies . the shortcomings of this study are its retrospective nature and the gathering of data from a single center rather than multicenter ( the latter of which could be more reprehensive of the population ) . in view of the results obtained in this study , we feel that grandmultiparity continue to pose additional risk for pregnancy outcomes even in modern obstetrics care . in a community where large family is desirable , again , conduction of good antenatal and intrapartum care will result in much reduction of these adverse outcomes for both fetus and mother .
aims : the aim of the current study was to determine the prevalence of grandmultiparity and the associated risks factors.methods:four hundred thirty grandmutliparas ( parity 5 or more ) were compared with multiparous population ( parity 2 - 4 ) with regard to maternal age , gestational age , mode of delivery , fetal and maternal outcomes and inter - current medical and obstetrical problems.results:there were significant association between grandmultiparity and adverse pregnancy outcomes such as cesarean delivery ( or=2.699 , ci=2.072 - 3.515 , p<0.001 ) , fetal macrosomia ( or=1.675 ; 95% ci=1.004- 2.796 , p=.048 ) , diabetes mellitus ( or=1.634 , 95%ci=1.076 - 2.481 , p=0.021 ) , and pregnancy induced hypertension ( or=1.838 , 95% ci=1.054 - 3.204 , p=.032 ) . 
 no significant associations were seen in placenta abruption , placenta previa , preterm labor , postpartum hemorrhage and the frequency of admission to neonatal intensive care unit . 
 no prenatal or maternal mortality was reported in this study.conclusion:grandmultiparty remains a major obstetrics problem . 
 it is associated with many medical and obstetrical complications . in communities where large family is desirable 
 it is important to address the value of family planning and conduction of meticulous antenatal care .