The outcome of grand-multiparous pregnancies of Arabic and Jewish populations in peripheral and central areas of Israel

Objective. To compare the antepartum and intrapartum course of Jewish and A rab great-grandmultiparas from central and peripheral areas in Israel to ag e-matched control multiparous women. Methods. Medical records of four groups of parturients were compared: great -grandmultiparas (para greater than or equal to9) and multiparae (para 2-5) delivering at Nazareth E.M.M.S. hospital(mostly Arabs) and Hadassah-Ein-Ke rem hospital in Jerusalem (mostly Jews). The control groups consisted of de mographically and geographically matched multiparas. Data was collected on prenatal care received, antepartum complications, as well as the intrapartu m complications traditionally associated with high parity (e.g. malpresenta tion, placental abnormalities, peripartum hemorrhage, shoulder dystocia). N eonatal records were also examined to determine any neonatal morbidity or m ortality. Results. There were 139 and 141 great-grandmultiparas in the Nazareth and t he Jerusalem study groups, respectively (mean parity was 10.1 and 10.9, res pectively), and 142 and 139 multiparas in the Nazareth and the Jerusalem co ntrol groups, respectively (mean parity was 2.9 and 2.5, respectively). The rate of physician visits during the prenatal period in the Nazareth and th e Jerusalem study groups was 2.3+/-2.4 and 3.2+/-2.7, respectively (p=0.004 1). This rate was significantly higher in the controls of both areas (4.0+/ -3.0 and 3.9+/-2.9, respectively). There was no difference in the rate of n urse visits in all groups in all areas. Maternal and neonatal outcomes were similar in both study groups, and were also similar in the control groups, but perinatal mortality was higher in both great-grandmultiparous groups c ompared to the controls (11/280 and 2/281, respectively; p<0.05). Conclusions. The differences in the intensity of prenatal care between thes e rural and urban areas did not affect the maternal outcomes of great-grand multiparous pregnancies. In addition, there were no significant differences in maternal outcomes between great-grandmultiparas and multiparas in rural and urban areas although prenatal care was less intense in the former. How ever, increased incidence of perinatal mortality in the great-grandmultipar as may be due to factors unrelated to prenatal care intensity or quality.