Impact of Primary Cesarean Section on Grand Multiparous Women

Kabbashi Mohammed Adam Hammad, Awadalla Abdelwahid Suliman*, Hajar Suliman Ibrahim Ahmed, Emad Abdalla Siddig Omer and Siddig Omer M Handady

Published: 11 September, 2023 | Volume 6 - Issue 3 | Pages: 126-131

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section.
Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications.
Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017.
An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded.
Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%. 
 Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%.
Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency. 

Read Full Article HTML DOI: 10.29328/journal.cjog.1001140 Cite this Article Read Full Article PDF


Impact; Primary; Cesarean section; Grand multiparous; Sudanese women


  1. Krishnan MV, Rao BK. Caesarean deliveries- Changing Trends. In: Arulkumaran S, Ratnam SS, Bhasker Rao K, Editors. The Management of Labour, 2nd Ed. Hyderabad, Orient Longman. 2015; 351-63.
  2. Basak S, Lahri D. Dystocia in eutocia multigravida. J Obstet Gynae Col India. 2015; 25:502.
  3. Rao JH, Rampure N. Study of Primary Caesarean Section in Multiparous Women. Journal of Evolution of Medical and Dental Sciences. 2013; l2(24):4414-18.
  4. Desai E, Leuva H, Leuva B, Kanani M. A study of primary caesarean section in multipara. Int J Reprod Contracept Obstet Gynecol. 2013; 2(3):320-324.
  5. Jacob S, Bhargava H. Primary caesarean section in multipara. J Obstet Gynaecol India. 2012; 22(6):642- 50.
  6. Solomons B. The dangerous multipara. Lancet. 1934; 2:8-11.
  7. Eidelman AI, Kamar R, Schimmel MS, Bar-On E. The grandmultipara: is she still a risk? Am J Obstet Gynecol. 1988 Feb;158(2):389-92. doi: 10.1016/0002-9378(88)90161-5. PMID: 3341414.
  8. Sreevidya S, Sathiyasekaran BW. High caesarean rates in Madras (India): a population-based cross sectional study. BJOG. 2003 Feb;110(2):106-11. PMID: 12618152.
  9. Elferink-Stinkens PM, Brand R, Van Hemel OJ. Trends in caesarean section rates among high- and medium-risk pregnancies in The Netherlands 1983-1992. Eur J Obstet Gynecol Reprod Biol. 1995 Apr;59(2):159-67. doi: 10.1016/0028-2243(95)02050-3. PMID: 7657010.
  10. Declercq E, Menacker F, Macdorman M. Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002. Am J Public Health. 2006 May;96(5):867-72. doi: 10.2105/AJPH.2004.052381. Epub 2006 Mar 29. PMID: 16571712; PMCID: PMC1470600.
  11. Jacob S. Hitesh Bhargava. Primary caesarean in multipara. J Obstet & Gynec India. 1972; 22(6):642-50.
  12. Palanichamy G. A study of 900 primary caesarean sections with special reference to 151 primary caesarean sections in grand multipara. J Obstet & Gynec India. 1976; 26:374-379.
  13. Goonewardene M, Manawadu MH, Priyaranjana DV. Audit: The Strategy to Reduce the Rising Caesarean Section Rates. J South Asian Feder Obst Gynae. 2012; 4(1):5-9.
  14. Shehata AI, Hashim TJ. Decrease in perinatal mortality and increase in cesarean section rates. Int J Gynaecol Obstet. 1995 Mar;48(3):261-7. doi: 10.1016/0020-7292(94)02282-4. PMID: 7781867.
  15. Guihard P, Blondel B. Trends in risk factors for caesarean sections in France between 1981 and 1995: lessons for reducing the rates in the future. BJOG. 2001 Jan;108(1):48-55. doi: 10.1111/j.1471-0528.2001.00009.x. PMID: 11213004.
  16. Al-Shaikh GK, Ibrahim GH, Fayed AA, Al-Mandeel H. Grand multiparity and the possible risk of adverse maternal and neonatal outcomes: a dilemma to be deciphered. BMC Pregnancy Childbirth. 2017 Sep 19;17(1):310. doi: 10.1186/s12884-017-1508-0. PMID: 28927391; PMCID: PMC5606064.
  17. Saxena N, Sharma B, Gupta V, Kamal S. Negi. A six-year appraisal of caesarean delivery at a teaching hospital in Uttarakhand. Int J Reprod Contracept Obstet Gynecol. 2016; 5(12):4369-72.
  18. Desai E, Leuva H, Leuva B, Kanani M. A study of primary caesarean section in multipara. Int J Reprod Contracept Obstet Gynecol. 2013; 320-324.
  19. Sethi P, Vijaylaxmi S, Shailaja G, Bodhare T, Devi S. A study of primary caesarean section in multigravidae. Perspectives in medical research. 2014; 2:37.
  20. Rao J, Rampure N. Study of primary caesarean section in multiparous women. jemds. 2013; 2(24):4414-4418.
  21. Saluja JK, Roy PK, Mahadik K. Study of primary caesarean section in multiparous women. NJIRM. 2014; 5(2).
  22. Reddy PSG, Ramana VS, Bhanu S. Clinical Study of Primary Caesarean Section inMultiparous Women. Indian Journal of Research. 2015; 4(10).
  23. Aftab S, Ali N, Saleh F, Ghafoor S. Indications of Primary Cesarean Section in Multipara JBUMDC. 2019; 9(2):105-108.
  24. Dasa TT, Okunlola MA, Dessie Y. Effect of grand multiparity on adverse maternal outcomes: A prospective cohort study. Front Public Health. 2022 Oct 13;10:959633. doi: 10.3389/fpubh.2022.959633. PMID: 36311606; PMCID: PMC9608575. Front. Public Health .202210: 959633.
  25. Baldo MH. Caesarean section in countries of the Eastern Mediterranean Region. East Mediterr Health J. 2008 Mar-Apr;14(2):470-88. PMID: 18561740.
  26. Carbonne B. Increase in cesarean delivery: are we facing a pandemic? Int J Gynaecol Obstet. 2009 Dec;107(3):183-4. doi: 10.1016/j.ijgo.2009.07.030. Epub 2009 Aug 27. PMID: 19716127.
  27. Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007 Feb 13;176(4):455-60. doi: 10.1503/cmaj.060870. PMID: 17296957; PMCID: PMC1800583.
  28. Tadevosyan M, Ghazaryan A, Harutyunyan A, Petrosyan V, Atherly A, Hekimian K. Factors contributing to rapidly increasing rates of cesarean section in Armenia: a partially mixed concurrent quantitative-qualitative equal status study. BMC Pregnancy Childbirth. 2019 Jan 3;19(1):2. doi: 10.1186/s12884-018-2158-6. PMID: 30606147; PMCID: PMC6318900.
  29. Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, Zhang J, Musana O, Wanyonyi SZ, Gülmezoglu AM, Downe S. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet. 2018 Oct 13;392(10155):1358-1368. doi: 10.1016/S0140-6736(18)31927-5. PMID: 30322586.
  30. Samal R, Palai P, Ghose S. Clinical study of primary cesarean section in multiparous women in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2016; 5:1506-9.
  31. Raudaskoski T, Gissler M. Monisynnyttäjän obstetriset erityispiirteet [Obstetric characteristics of a grand multipara]. Duodecim. 2014;130(13):1309-17. Finnish. PMID: 25095478.
  32. Roy R, Vernekar M. Feto-maternal outcome in grand multipara. Int J Reprod Contracept Obstet Gynecol. July 7, 2017; 6: 2846-2851.
  33. Khan NR, Perveen S, Begum Z, Qayyum R, Malik R. Grand multiparity and maternal outcome in absence of adequate antenatal care J Postgrad Med Inst. 2017; 31(1):67-71.
  34. Alhainiah MH, Abdulljabbar HSO, Bukhari YA. The Prevalence, the Fetal and Maternal Outcomes in Grand Multiparas Women. Mater Sociomed. 2018 Jun;30(2):118-120. doi: 10.5455/msm.2018.30.118-120. PMID: 30061801; PMCID: PMC6029909.
  35. Glodean DM, Miclea D, Popa AR. Macrosomia. A systematic review of recent literature Rom J Diabetes Nutr Metab Dis. 2018; 25(2):187-195.
  36. Alshammari RF, Khan FH, Alkwai HM, Alenazi F, Alshammari KF, Sogeir EKA, Batool A, Khalid AA. Role of Parity and Age in Cesarean Section Rate among Women: A Retrospective Cohort Study in Hail, Saudi Arabia. Int J Environ Res Public Health. 2023 Jan 13;20(2):1486. doi: 10.3390/ijerph20021486. PMID: 36674239; PMCID: PMC9865448.
  37. Antoine C, Young BK. Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly. J Perinat Med. 2020 Sep 4;49(1):5-16. doi: 10.1515/jpm-2020-0305. PMID: 32887190.
  38. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021 Jun;6(6):e005671. doi: 10.1136/bmjgh-2021-005671. PMID: 34130991; PMCID: PMC8208001.
  39. Ahmed AE, Mohammad RS. Cesarean sections. Associated factors and frequency at King Abdulaziz Medical City in the Central Region of the Kingdom of Saudi Arabia. Saudi Med J. 2018 Nov;39(11):1154-1157. doi: 10.15537/smj.2018.11.22499. PMID: 30397716; PMCID: PMC6274665.
  40. Martinelli KG, Gama SGND, Neto S, ETD. The role of parity in the mode of delivery in advanced maternal age women. Revista Brasileira de Saúde Materno Infantil. 2021; 21:65–75.
  41. Deng R, Tang X, Liu J, Gao Y, Zhong X. Cesarean delivery on maternal request and its influencing factors in Chongqing, China. BMC Pregnancy Childbirth. 2021 May 19;21(1):384. doi: 10.1186/s12884-021-03866-7. PMID: 34011289; PMCID: PMC8132350.


Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?