HIGH MULTIPARITY - STILL AN OBSTETRICAL P ROBLEM

The high multipara is still accused of a higher incidence of intra- an d postpartum complications. Therefore, we compared 280 high multipara (5-11 para) with a group of 280 age-matched multipara (2-4 para) out o f 15 666 deliveries, all performed between 1984 and 1994 at the Depart ment of Gynaecology and Obstetrics of the Technical University Dresden , Germany. We focussed on the incidence of intrapartum complications, also related to antepartal care, disorders of pregnancy and preexistin g diseases. Furthermore, we compared the results with 48 357 deliverie s of the Saxonian Perinatal Studies (SPS) in 1992 and 1993. There was no significant (n.s.) difference concerning antepartal risks and overa ll intrapartum complications (32.9% vs. 31.1%; SPS: 25.1%). No signifi cant difference was found concerning pre- and postterm delivery, fetal malpresentation, birth weight, fetal outcome, duration of birth, dysf unctional birth requiring oxytocin, placentar period, placenta adheren s, atonia, subinvolutio uteri, postpartal haemorrhage, stillbirth and eclampsia. Placenta praevia (3.9% vs. 1.4%; n.s.; SPS: 0.4%), preterm labour <32. week (9.3% vs. 5.7%; n.s.: SPS: 1.0%) and postpartal trans fer of the newborn to neonatal-ICU (18.5% vs. 14.9%; n.s.) did not dif fer significantly in both groups. Instead, with the high multipara the re was a significantly lower rate of Caesarean section (12.9% vs. 20.5 %; p < 0.05; SPS: 12.1%), of forceps and vacuum deliveries (2.1% vs. 7 .3%; p < 0.01; SPS: 6.6%), a shorter average birth duration (3.41 h vs . 4.04 h; n.s.), less need of oxytocin during delivery (51.8% vs. 60.0 %; n.s.), a shorter placentar period (9.0 min vs. 9.7 min; n.s.), a lo wer rate of acute intrapartal tocolysis (1.8% vs. 5.6%; n.s.) and a be tter arterial chord pH (> 7.29: 44.2% vs. 32.9%; < 7.19: 12.9% vs. 15. 9%). Some risk may result from the fact that 41.8% of the high multipa ra are 35 years of age and older (SPS: 6.9%), probably have a more dif ficult socioeconomic status with bigger families and due to the possib le disbelief that, because of greater experience in childbearing, less prenatal care is needed.