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PubMed2004

Histomorphologic and morphometric evaluation of the uterine horns in nulliparous and multiparous Beagles.

OBJECTIVE: To macroscopically, histomorphologically, and morphometrically compare uterine tissues obtained from nulliparous and multiparous dogs. ANIMALS: 12 dogs constituting 2 homogenous groups (7 nulliparous Beagles and 5 multiparous Beagles, each of which had at least 7 pregnancies). PROCEDURE: Serum concentrations of progesterone and estradiol-17beta were determined. Samples of uterine tissues were fixed, embedded in paraffin, and cut into serial cross sections. Morphometric analysis was performed on systematically selected trichrome-stained sections. RESULTS: Mean absolute volume of the uterine wall did not differ between groups. Volume of blood vessels was significantly higher and relative mean value for myometrial connective tissue was significantly lower in the multiparous dogs. Arteries in the myometrium of multiparous dogs had pronounced thickening of the intima (ie, pregnancy sclerosis) and a concomitant thinning of the smooth muscle layer (tunica media). Furthermore, the elastica interna of these arteries appeared to be disintegrating and was highly and irregularly folded. Adventitia of the myometrial veins in multiparous dogs contained numerous layers of elastic fibers; however, only a few layers were observed in the adventitia of corresponding veins in nulliparous dogs. CONCLUSIONS AND CLINICAL RELEVANCE: In this study, we documented that in contrast to other species, the uterus of nonpregnant dogs does not increase in size and volume even after at least 7 pregnancies. Furthermore, sclerotic alterations of uterine arteries are proof of at least 1 pregnancy. Results of this study may be useful in the evaluation of uterine diseases.

Animals↗
PubMed1995

Chronological changes in subjective symptoms during pregnancy in nulliparous and multiparous women.

BACKGROUND: To investigate chronological changes of subjective symptoms during a normal pregnancy in nulliparous and multiparous women. METHODS: Prospective data were collected using a 20-item questionnaire (general fatigue, headache, palpitation, nausea/vomiting, fever, insomnia, edema, abnormal abdominal size, urinary frequency, lumbago, fetal descent, genital bleeding, watery discharge, high frequency of uterine contraction, increase in frequency of uterine contraction, strong intensity of uterine contraction, increase in intensity of uterine contraction, no change of uterine contraction at rest, high frequency of fetal movements, strong intensity of fetal movements) at Tsushima Izuhara Hospital in Nagasaki Prefecture, Japan. Seven hundred and twenty-nine nulliparous and 588 multiparous normal pregnant women were questioned from 1988 to 1992. A simple (chi-square test) analysis of appearance percentages in each item for every term of pregnancy was made. RESULTS: Each symptom showed different chronological patterns. In the simple analysis, there were significant differences (p < 0.05) in 10 symptoms (headache, palpitation, fever, insomnia, lumbago, fetal descent, watery discharge, increase in frequency of uterine contraction, strong intensity of uterine contraction, strong intensity of fetal movements) between nulliparous and multiparous subjects. In the multiparous group, there was a higher severity in eight of the ten symptoms, except for fever and watery discharge. CONCLUSIONS: The multiparous group had more complaints than did the nulliparous subjects. These normal patterns are of practical clinical use concerning subjective symptoms of pregnancy.

Chronology as Topic↗
PubMed2001

The effects on production and behavior of mixing uniparous and multiparous cows.

The production and behavior of a group of eight multiparous and eight uniparous cows after they were mixed were compared with unmixed groups of 16 multiparous and 16 uniparous cows. The cows grazed pasture (mean height 16 cm) in treatment groups in a daily paddock rotation. The milk yield of mixed cows was 3% less in the first week than cows in the unmixed groups, and 1% less in the 6 wk after mixing. The reduction in milk yield was similar for uni- and multiparous cows. Both uni- and multiparous cows in the mixed group grazed for less time and they stood for longer, particularly in the first week postmixing. The multiparous cows in the mixed group increased their pasture biting rate and became more dominant than the uniparous cows, who spent more time grooming other cows and in aggressive interactions compared with the unmixed group of uniparous cows. We concluded that the mixing of multi- and uniparous cows causes disruption to their grazing and social behavior, which results in a reduction in milk yield.

Aggression↗
PubMed2003

Is grand multiparity an independent predictor of pregnancy risk? A retrospective observational study.

OBJECTIVE: To determine whether high maternal parity has any effect on pregnancy outcome independent of other maternal characteristics. DESIGN AND SETTING: Retrospective observational study using the database of a referral obstetric unit in a 280-bed regional hospital in far north Queensland. PARTICIPANTS: All 15 908 women who had singleton births between 1992 and 2001, comprising 653 women with grand multiparity (>or= 5 previous births at gestation >or= 20 weeks) and 15 255 women with lower parity. MAIN OUTCOME MEASURES: Spontaneous vaginal birth, postpartum haemorrhage (estimated blood loss > 500 mL), placental retention requiring manual removal, blood transfusion associated with the birth, and perinatal death. RESULTS: Women with grand multiparity were significantly older than those with lower parity, more likely to be Indigenous, not to have had antenatal care, to have smoked during pregnancy and to have had one or more previous caesarean sections. On univariate analysis, women with grand multiparity were more likely to have a postpartum haemorrhage (9.2% v 5.3%) and blood transfusion (2.8% v 1.5%). However, multivariate logistic regression analysis of women who began labour (ie, did not have an elective caesarean section) showed that grand multiparity was not significantly associated with postpartum haemorrhage or blood transfusion when other maternal characteristics were included in the model (regression coefficients [95% CI], 1.36 [0.99-1.87] and 1.09 [0.59-2.02], respectively). However, they remained more likely to have a spontaneous vaginal birth (regression coefficient [95% CI], 2.10 [1.56-2.74]). CONCLUSIONS: Women with grand multiparity do not have an increased likelihood of poor pregnancy outcomes. Birth-suite protocols which dictate extra interventions as routine during labour in these women should be revised.

Adult↗
PubMed1992

Neural and endocrine sensitivities to opioids decline as a function of multiparity in the rat.

Hormonal changes during pregnancy regulate the onset of maternal behavior at parturition. In addition, the concentrations of beta-endorphin and mu opioid receptors are higher during pregnancy and lower during lactation. Previous studies have shown that sensitivity of female rats to the disruptive behavioral effects of morphine changes as a function of the number of pregnancies and/or lactations the females undergo. The objectives of the present study were to determine whether central infusions of the endogenous opioid, beta-endorphin, would disrupt maternal behavior. Next, we investigated the possibility that the neural sensitivity to beta-endorphin changes with repeated pregnancies. And finally, we examined whether opioid-mediated endocrine responses also change as a function of multiparity. In the first study, bilateral infusions of low doses (0.06-0.72 nmol) of beta-endorphin into the medial preoptic area (MPOA) of lactating, primiparous rats disrupted maternal behavior. When comparable doses of beta-endorphin were infused into the MPOA of age-matched, multiparous rats, the behavioral effects of beta-endorphin were significantly attenuated. In response to suckling stimulation, an opioid-mediated endocrine response, primiparous mothers secreted more prolactin than did multiparous rats. Moreover, multiparous, but not primiparous, mothers were insensitive to the ability of naloxone, an opiate antagonist, to block suckling-induced increases in prolactin. These findings indicate that reductions in neural sensitivity to opioids develop as females undergo repeated pregnancies and lactations, changes which affect both behavioral and endocrine functions.

Animals↗
PubMed2004

Use of Ovsynch in dairy herds--differences between primiparous and multiparous cows.

Ovsynch protocols are used to increase service rate and decrease days open and cullings for infertility. Recent reports have indicated better results after Ovsynch in primiparous than in older cows. However, this was not observed in all investigations on the subject. The objective of the study was to evaluate differences between primiparous and multiparous cows after synchronization of ovulation with an Ovsynch protocol in six trials. A total of 1584 cows (583 primiparous and 1001 multiparous cows, respectively) on three dairy farms were synchronized with an Ovsynch protocol consisting of a GnRH-analogue at Days 0 and 9, and a prostaglandin F(2alpha) analogue on Day 7. AI was carried out in all cows 16-20 h after the last treatment. Cows were categorized into primiparous and multiparous cows for analysis. Conception rate (CR) to timed AI, to further AI, overall conception rate and proportion of cows pregnant by 200 days in milk were compared between the age groups. Finally, two logistic regression models were calculated with conception to first service and conception by 200 DIM as the outcome variables. Independent variables were trial (categorical) and age group (primiparous versus multiparous). Conception rates to TAI were higher in primiparous than in older cows (37.9% versus 31.6%, P=0.015). Likewise pregnancy rates by 200 DIM were higher in primiparous cows (81.8% versus 75.4%, P=0.003). However, the extent of the difference varied between trials. Results indicate that Ovsynch protocols are more effective in primiparous than in older cows.

Aging↗
PubMed1999

Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric risk factors.

OBJECTIVE: We sought to compare obstetric and neonatal complications among great-grand multiparous, grand multiparous, and multiparous women. STUDY DESIGN: One hundred thirty-three great-grand multiparas, 314 grand multiparas, and 2195 multiparas who were delivered of their infants between 1988 and 1998 were selected for the study. To facilitate comparison, the patients were all >35 years old and had similar socioeconomic characteristics. RESULTS: The incidence of malpresentation at the time of delivery, maternal obesity, anemia, preterm delivery, and meconium-stained amniotic fluid increased with higher parity, whereas the rate of excessive weight gain and cesarean delivery decreased. Compared with grand multiparas, great-grand multiparas had significantly elevated risks for abnormal amounts of amniotic fluid, abruptio placentae, neonatal tachypnea, and malformations but lower rates of placenta previa (P <.05). The incidence of postpartum hemorrhage, preeclampsia, placenta previa, macrosomia, postdate pregnancy, and low Apgar scores was significantly higher in grand multiparas than in multiparas, whereas the proportion of induction, forceps delivery, and total labor complications was significantly lower than in the multiparous group (P <.05). Similar frequency of maternal diabetes, infection, uterine wall scar rupture, variations in fetal heart rate, fetal death, and neonatal mortality was found in the 3 groups. CONCLUSION: Both high-parity groups have their own risk factors, but the rate of some complications decreases with higher parity. In addition, perinatal mortality remains low in these patients, and therefore, under satisfactory socioeconomic and health care conditions, high parity should not be considered dangerous.

Adult↗
PubMed1999

Singleton term breech deliveries in nulliparous and multiparous women: a 5-year experience at the University of Miami/Jackson Memorial Hospital.

OBJECTIVE: The purpose of this retrospective study was to evaluate the feasibility of planned vaginal delivery, the maternal morbidity and mortality, and the short-term perinatal outcome in selected multiethnic women at term with singleton breech presentations. STUDY DESIGN: Singleton breech deliveries were identified from the delivery database between January 1, 1989, and December 31, 1993. A retrospective chart review identified 310 nulliparous and 711 multiparous women at term (37-42 weeks) for a total of 1021. Parameters studied included the success rate of planned vaginal deliveries and the incidences of maternal morbidity, perinatal morbidity, and mortality as a whole stratified by parity and mode of delivery. The Student t test, chi(2) test, and Fisher exact test were used for statistical analysis. RESULTS: Among 1021 women with singleton fetuses in a breech position at term, 191 were candidates for vaginal delivery, and 135 (70.7%) of these deliveries were successful. By parity, 12.3% of 310 nulliparous women and 21.5% of 711 multiparous women were candidates for vaginal delivery; 50% of the former and 75.8% of the latter underwent vaginal delivery. Maternal morbidity was more commonly associated with multiparity and cesarean delivery. Newborn intensive care admissions were equally distributed by parity, and significantly more were for vaginal than cesarean deliveries (17.4% vs 10.8%, P =.036). Premature rupture of the membranes complicated deliveries in 23.9% of the nulliparous women and only 6.5% of the multiparous women (P =.000). CONCLUSION: In this multiethnic population 70.7% of candidates selected for attempted vaginal breech delivery at term were successful. The remaining 29.3% underwent cesarean delivery for labor disorders or nonreassuring fetal heart rate patterns.

Birth Injuries↗
PubMed1999

Effect of multiparity on T-cell proliferation response to mitogen stimulation in elderly women.

The purpose of the present study was to investigate whether multiparity in women prevents some age-related changes in their cell function, as is known for age and sex. 49 women from the same village, free of acute inflammation or neoplastic diseases, were selected and divided into the following three groups: nulliparous 1935 years old, nulliparous 65 92 years old and multiparous (3-9 pregnancies) 65-88 years old. The response of their blood-lymphocytes to phytohaemagglutinin-P was estimated by thymidine uptake, number of mitoses and number of sister-chromatid exchanges. The stimulation index, mitotic index and proliferative rate in the aging nulliparous women were significantly lower than in the younger nulliparous women, but the latter group (young nulliparous) did not differ in their lymphocyte parameters assayed, from the values in the aging multiparous women breast-feeding their newborn. It is concluded that when the proliferative capacity to mitogen in elderly multiparous women (after 3-9 pregnancies) is related to breast feeding, it is similar to the proliferative capacity in young women. We suggest therefore, that breast feeding is beneficial not only to the newborns, but also to their mothers.

Adult↗
PubMed2003

Timing of ovulation and conception rate in primiparous and multiparous cows after synchronization of ovulation with GnRH and PGF2alpha.

Conception rates after Ovsynch have been higher in primiparous than in multiparous cows. The objective of this study was to investigate whether this difference might be due to differences in ovulation rate or follicular size. The experiment was conducted with 136 Holstein Frisian cows from a commercial herd in Brandenburg, Germany. All cows were synchronized using Buserelin (GnRH analogue) at day -10, Tiaprost (PGF2alpha analogue) at day -3 and again GnRH at day -1. Timed artificial insemination (TAI) was carried out 16-20 h after the second dose of GnRH on day 0. Milk samples for analysis of milk progesterone were obtained on days -17, -10, -3 and at TAI. Progesterone concentrations were used to determine the stage of oestrus cycle at the start of the synchronization protocol and to investigate the presence of functional luteal tissue before treatment with PGF2alpha and TAI. All animals were examined by ultrasound at the second treatment with GnRH, at AI, 8 and 24 h after AI. Overall synchronization rate (proportion of cows with an ovulation within 40 h after GnRH) was 86.8% in primiparous and 88.2% in multiparous cows, respectively. Ovulation occurred earlier in primparous than in multiparous cows (p < 0.05) and ovulatory follicles were smaller. Conception rates were numerically higher in primiparous cows but the difference was not significant. Cows that displayed signs of oestrus on day -1 and received an additional AI on this day were more likely to conceive than cows that only received TAI 16 to 20 h after GnRH2. It is concluded that ovulation occurs earlier in primiparous than in multiparous cows after Ovsynch. However, a significant relationship between these differences and the probability of conception could not be established.

Animals↗
PubMed2001

Hormone replacement therapy for bone protection in multiparous women: when to initiate it.

OBJECTIVE: Hormone replacement therapy is used in postmenopausal women to improve symptoms of menopause and to protect bone and the cardiovascular system. We have evaluated the effects of parity in terms of number of deliveries on bone density and fracture risk at different ages. STUDY DESIGN: We evaluated 1875 Hispanic women > or =50 years old (61.3 +/- 8.3 years), 425 with a history of nonselective fractures and 1450 without previous fractures. Body mass index was 27.3 +/- 4.3 kg/m(2). Bone mineral densities were determined for the total body in 1468 cases, the femur in 221 cases, and the lumbar spine in 189 cases. Women were classified according to lifetime number of deliveries (from 0 to > or =5), and bone mineral densities and odds ratios for fracture risk were calculated relative to the number of deliveries. RESULTS: Bone mineral densities in total body, pelvis, and legs and total calcium and total mineral contents increased (P <.001) with > or =2 deliveries among women 50 to 59 years old but not among those > or =70 years old. The prevalence of fractures was higher in nulliparous than in multiparous women at all ages. Fracture risk was lower in multiparous women at all age groups, including those > or =70 years old (odds ratio, 0.47; 95% confidence interval, 0.26-0.84; P <.006). CONCLUSION: Bone mineral density increases with the number of deliveries until the age of 69 years. Fracture prevalence and fracture risk are lower among multiparous women even at older ages. These findings suggest that hormone replacement therapy can be delayed until 65 years of age for multiparous women but should be initiated at the beginning of menopause for nulliparous women.

Aged↗
PubMed1998

Influence of early post partum ovulation on the re-establishment of pregnancy in multiparous and primiparous dairy cattle.

To investigate the influence of early ovulation after calving on subsequent fertility, milk progesterone concentrations were monitored twice weekly in multiparous (n = 87) and primiparous (n = 60) Holstein/Friesian dairy cattle. Luteal activity before 21 days post partum was defined as 'early'. In multiparous cows, calving-to-conception interval (CCI) was longer, services per cow were more numerous and conception rate to all inseminations was lower with early luteal activity (n = 41, 16.8 +/- 0.39 days post partum) than with later luteal activity (n = 46, 37.8 +/- 2.09 days post partum); multiparous cows with early luteal activity required more exogenous fertility treatments and were more likely to fail to conceive by 100 days post partum. In contrast, in primiparous cows, no significant relationships were detected between early (n = 32) or later (n = 28) luteal activity and the CCI, number of services per cow or conception rates to all inseminations. However, primiparous cows that ovulated before 21 days post partum had fewer normal progesterone profiles. Early ovulation after calving was associated with reduced pregnancy rates and prolonged CCIs in multiparous but not in primiparous dairy cows.

Animals↗
PubMed2001

Oxytocin use in grand-multiparous patients: safety and complications.

OBJECTIVE: To determine whether the use of oxytocin for the augmentation of labor in grandmultiparous women increases the risk of peripartum complications. STUDY DESIGN: During the years 1989-97, 11 075 grand-multiparous women delivered at our institution. In 424 grand-multiparous women, intravenous oxytocin was used for augmentation of labor. The control group consisted of the other 10 651 grand-multiparous women. All women were monitored for fetal heart rate and uterine contractions. We compared the rates of maternal and perinatal complications in these two groups by using chi(2) analysis and Fisher's exact test when appropriate. RESULTS: No significant differences were found between the oxytocin and the control groups in the rates of placental abruption, intrapartum fetal death, postpartum hemorrhage, uterine rupture, fetal distress, meconium-stained amniotic fluid, an Apgar score of less than 7 at 5 min, Cesarean section, retained placenta and vaginal and cervical lacerations. In contrast, a significant increase in the rate of vacuum deliveries was observed in patients given oxytocin as compared to controls (3.5% vs. 1.4%, respectively; p = 0.001). CONCLUSIONS: The use of oxytocin in the grand-multiparous parturient was a safe procedure with no significant increase in peripartum complications. However, a higher rate of vacuum deliveries was found.

Adult↗
PubMed2004

Obstetric and neonatal outcomes in grand multiparity.

OBJECTIVE: To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among grand multiparas with age-matched multiparas. METHODS: Six hundred twenty-one grand multiparas (para more than 4) women were prospectively compared with 621 age-matched multiparous (para 2-4) controls. RESULTS: Grand multiparity was associated with low socioeconomic status and education (odds ratio [OR]6.4; 95% confidence interval [CI] 4.5, 9.0), poorer prenatal care (OR 3.1; 95% CI 1.5, 6.1), smoking (OR 2.2; 95% CI 1.5, 3.2), and alcohol consumption (OR 9.0; 95% CI 2.1, 39.3). Grand multiparas had a higher body mass index (OR 1.5; 95% CI 1.2, 1.9) and rate of insulin-dependent gestational diabetes (OR 1.7; 95% CI 1.02, 3.1). They had more previous intrauterine (OR 4.2; 95% CI 1.5, 11.3) and perinatal deaths (OR 3.2; 95% CI 2.0, 5.0). They had fewer intrapartum complications (arrests of cervical dilatation [OR 0.19; 95% CI 0.06, 0.66], instrumental deliveries [OR 0.31; 95% CI 0.16, 0.59], and fever during labor [OR 0.47; 95% CI 0.26, 0.86]). Conditional logistic regression models found that grand multiparity was the most closely correlated factor to a previous history of fetal death (OR 4.3; 95% CI 1.6, 11.6), but it was not an independent predictor of insulin-dependent gestational diabetes mellitus (OR 1.3; 95% CI 0.75, 2.2). CONCLUSION: Grand multiparas, when compared with same-age multiparous controls, appear to have fewer intrapartum complications. However, they present several prenatal risk factors that require special antenatal care. LEVEL OF EVIDENCE: II-3

Adult↗
PubMed2004

Intraabdominal pressure after full abdominoplasty in obese multiparous patients.

This study measured intraabdominal pressure in morbidly obese and multiparous patients who underwent abdominoplasty with musculoaponeurotic plication. The purpose of this study was to evaluate any potential adverse effect on pulmonary function by virtue of pulmonary function tests and measurement of peak airway pressure. The study included 43 multiparous, morbidly obese women (mean body mass index, 35.8 kg/m2) with a mean age (+/- SD) of 38.6 +/- 7 years. All had full abdominoplasty and repair of the musculoaponeurotic system during the period from June of 1999 to May of 2002. Forty-three morbidly obese multiparous patients were seen over a period of 24 months. Their intraabdominal pressure was estimated by measuring the intravesical pressure before and after repair of severe diastases (divarication) of the rectus abdominis muscles with severely flaccid myofascial component before using a hydrometer connected to a Foley catheter both before and after repair. All patients had pulmonary function checked before and 2 months after the repair. The study confirmed that there are minimal changes on the intraabdominal pressure parameters compared with measurement before and after full abdominoplasty with plication of the rectus muscles, with minimal to negligible changes in the intrathoracic pressure. These changes are clinically and statistically significant (p < 0.0001). The study also recommended the safety of full abdominoplasty and repair of the musculoaponeurotic system in multiparous and morbidly obese patients. Furthermore, no statistically significant difference was found in pulmonary function parameters before and after surgery in patients with a history of bronchial asthma.

Abdominal Cavity↗
PubMed1984

Sera from multiparous women contain antibodies mediating cytotoxicity against breast carcinoma cells.

We have searched for immunological mechanisms contributing to the epidemiologically established phenomenon of lower incidence of breast carcinoma among multiparous women and women with pregnancy at early age. Sera collected from 55 clinically healthy multiparous women were tested for the ability to mediate cytotoxicity in an antibody-dependent cell-mediated (ADCC) assay with normal blood leucocytes against three different mammary carcinoma cell lines (MDA-MB 157, MDA-MB 231, and MDA-MB 436). Sera from 12 women (22%) mediated significant cytolysis against all three cell lines. Three additional sera were positive against MDA-MB 231 and 10 more against MDA-MB 436 (total 42%). Cross-adsorptions revealed that the ADCC-active sera contained antibodies that recognized the same antigen(s) on the different mammary carcinoma-derived cell lines. The sera from multiparous women contained no detectable ADCC-active antibodies against a colon carcinoma cell line (SW 1116) or a neuroblastoma cell line (SH-SY5Y). ADCC-active antibodies were found neither in sera from 35 nulliparous women nor in sera from 20 men. The ADCC-active antibodies against mammary carcinoma cells could not be removed by adsorption with lymphoblastoid cells established from the respective husbands of the multiparous women. This observation and the fact that the mammary carcinoma cell lines were established from different patients argue against an impact of HLA-related antigens. The ADCC-active antibodies reported here might result from autoimmunization against some proliferation/differentiation antigen(s) of breast epithelium which is (are) expressed during pregnancy and lactation.

Antibody-Dependent Cell Cytotoxicity↗
PubMed2003

Multiparity induces priming to male-specific minor histocompatibility antigen, HY, in mice and humans.

One of the factors that increases the risk of graft-versus-host disease following allogeneic stem cell transplantation is the use of multiparous females as donors. Since minor histocompatibility (H) antigens are the main targets of graft-versus-host and graft-versus-leukemia responses, we tested the hypothesis that multiparity could prime minor H antigen-specific T cells. We examined the peripheral lymphoid populations of multiparous mice and humans for evidence of priming of CD8+ T-cytotoxic lymphocytes against peptide epitopes of the male-specific minor H antigen, HY. In contrast to naive females, multiparous females have measurable levels of circulating HY-specific tetramer-positive T lymphocytes, which can be readily expanded in vitro. These findings have implications for the in vitro generation of T-cell clones as reagents for immunotherapy for tumors following stem cell transplantation.

Animals↗
PubMed2006

Does practice make perfect? An age-matched study on grand multiparity in Flanders, Belgium.

AIM: To compare the perinatal outcome of grand multi-parous women (giving birth for the fifth to ninth time) and pauciparous (parity 2 to 4) women in the region of Flanders, Belgium. METHODS: Population-based, retrospective, age-matched study. RESULTS: 2832 grand multiparous women were compared with 2832 pauciparous women. In univariate analysis grand multiparous women showed more transverse lie, macrosomia, and fetal death and had less frequently epidural analgesia and episiotomy. Logistic regression demonstrated that grand multiparity was a significant factor contributing to fetal death and macrosomia. CONCLUSION: Grand multiparity is associated with fetal death and macrosomia in the region of Flanders, Belgium.

Analgesia, Epidural↗