Volume 180 - Issue 4
Is grand multiparity an independent predictor of pregnancy risk? A retrospective observational study
Author: Michael D Humphrey
Med J Aust 2004; 180 (4): 196-197. || doi: 10.5694/j.1326-5377.2004.tb05872.x
Published online: 16 February 2004
Published online: 16 February 2004
Michael D Humphrey
Director, Obstetrics and Gynaecology, Women's and Children's Health Service, King Edward Memorial Hospital, PO Box 134, Subiaco, WA 6904. Michael.HumphreyAThealth.wa.gov.au
In reply: I thank de Costa for her interest in the debate about excessive medicalisation of normal childbirth in women with significant parity. The obstetric protocol manual of Cairns Base Hospital did not, at any time, discriminate in the details of management of the third stage of labour between grand multiparous and non-grand multiparous women.
The statistical analysis in my report shows that, once confounding factors are accounted for, grand multiparous women who labour spontaneously are twice as likely as their less parous counterparts to have a spontaneous vaginal birth, with no statistically greater risk of a postpartum haemorrhage requiring transfusion.1 The purpose of multivariate analysis is to remove, as far as possible, the influences of the confounding factors that de Costa’s appraisal relies on.
The recommendation from my study is not that grand multiparous women be ignored, but that, if labour occurs spontaneously at the end of an uncomplicated pregnancy, they be treated no differently to their less parous sisters in terms of venous cannulation and blood cross-matching. I am on record as strongly recommending sensible, routine oxytocin-based management of the third stage of labour in all pregnancies.2
In the end, the question is whether or not evidence wins out over an individual’s historically influenced clinical beliefs.
References
- Humphrey MD. Is grand multiparity an independent predictor of pregnancy risk? A retrospective observational study. Med J Aust 2003; 179: 294-296. <eMJA full text>
- Humphrey MD. The obstetrics manual. Sydney: McGraw-Hill, 1995: 20. i1082879
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