Objective: To find out the effect of grand multiparity on maternal outcome in absence of adequate antenatal care. In third world countries like Pakistan the large families are still common. A grand multipara relates to a pregnant mother who has got previous mother who has got previous four or more viable births. [2] Juntunen K, Kirkinen P, Kauppila A. HIGH RISK. The incidence of grand multipara has decreased in most western countries in recent years due to better socioeconomic status and high use of contraception11,12,13. The incidence of LSCS was more (38.7% vs 34.7%) in multipara. Acta Obstet Gynecol Scand 1997;76(8):755–9. A grand multipara is a woman who has already delivered five or more infants who have achieved a gestational age of 24 weeks or more, and such women are traditionally considered to be at higher risk than the average in subsequent pregnancies. It has been shown that the best obstetric outcome is often seen in women who are para 1, 2 … Definition: High risk pregnancy is defined as one which is complicate by factor or factors that adversely affects the pregnancy outcomes maternal or perinatal or both.. Contraindications a) In late pregnancy • Grand multipara • Contracted pelvis • History of LSCS or hysterectomy • Malpresentation b) During labour 1. This study is based on 5785 cases of GM which were treated in our Obstetrical Department during a period of 16 years (1960 – 1975). A review of 5785 cases. However, a number of reports have recently appeared in the literature suggesting that this might be fiction rather than fact [1] . High Risk Pregnancy. Obstructed labour 2. ELSEVIER European Journal of Obstetrics & Gynecology and Reproductive Biology 61 (1995) 105-109 The grand multipara Gil A. Goldman*, Boris Kaplan, Alexander Neri, Rivka Hecht-Resnick, Linda Harel, Jardena Ovadia Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, P. O.Box 65171. Having a heterogenous population, the problem of Grand Multiparity still exists in our country. Great grand multipara also have a higher incidence of macrosomia (12% vs. 12%) P < 0.0001. Methodology: All un-booked grand multipara with singleton pregnancy at term admitted to Gynae A Unit, Lady Reading Hospital Peshawar were included in the study. PREGNANCY ASSESSMENT AND MANAGEMENT. High risk pregnancy is defined as one in which the mother, fetus or newborn are at increased risk of morbidity or mortality before, at or after birth [2] . Int J Gynecol Obstet 1985;23(4):321–6. Some risk factors may later appear and are detected at grand multipara compared to 61.2% in control group. A grand … SCREENING AND ASSESSMENT Initial antenatal examination - in the first trimester of pregnancy. The clinical outcome in pregnancies of grand grand multiparous women. The “grand multipara”–is it a problem? Grand multipara in relation to obstetric performance is labelled high risk. Cross sectional study was carried out from 1st June 2012 to 1st Dec 2012. [3] Fuchs K, Peretz BA, Marcovici R, Paldi E, Timor-Tritsch I. Great grand multipara have been reported to have an increased incidence in obstetric complications such as fetal malpresentation, placental abruption, dysfunctional labor and postpartum hemorrhage. Incidence The incidence has been gradually declining over the couple of decades due to acceptance about one-tenth of the hospital populations and accounts for 1/3 of the maternal death in the developing countries. The Grand Multipara (GM) has almost disappeared in the Western countries due to the advancement of family planning. 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