Grand grand multiparity is associated with many complications to both mother and fetus.
These might occur during the period of the ante, intra and post partnllTI period. So, the aim of this
study consists of two folds ; 1- To evaluate the maternal and neonatal morbidity and mortality in
the grand grand multiparous women and 2- To examine the effects of planned nursing intervention
on the maternal and neonatal morbidity and mortality. Total of the 460 pregnant women were
recruited in the study. 400 pregnant women were subdivided into four groups according to their
parity primigravidea, multipara, grand multipara and grand grand multripara (assessment group).
While 60 of the pregnant women were grand grand mUltiparity (intervention group). The methods
of data collection were interviewing questionnaire (sociodemographic data, obstetrical data,
history of present complain etc ... ), Partograph to monitor progress of labor, maternal as well as
fetal condition, Apgar scores is to evaluate the infant's cardio respiratory adaptation after birth.
Results revealed that the mean age was 21.9 ± 3.6, 28 ± 4.4, 35.1 ± 4.2, 40.1 ± 2.7,37.8 ± 3.4 in
the primigravidea, multipara, grand multipara, and grand grand multipara (assessment and
intervention groups), respectively. About 62 % and 50% of women with the grand grand
multiparity (assessment and intervention groups, respectively) were delivered vaginally as
compared to other parities 74%, 67%, 73%. On the other hand, the higher rate of cesarean section
31 % and 46.7% was observed in the grand grand multiparity (assessment and intervention groups,
respectively). Furthermore, the frequencies of the low birth weight and cephalopelvic
disproportion were slightly high in the intervention group as compared to the assessment group.
There were no statistically significant differences between the assessment and the intervention
groups of the grand grand multiparity regarding to the incidence of diabetes mellitus, anemia, and
premature rupture of membranes, oligohydramnious and placenta abruption. Also, there were
statistically significant differences between the two groups regarding to induction, cesarean
section, and post term delivery. The rate of post partum hemorrhage was 5%, 8% in the
intervention and assessment groups, respectively. Moreover, the frequency of eclampsia was
higher in the intervention as compared to the assessment group 16.7%, 7%, respectively. Mean
Apgar score at the first minutes and fifth minutes in the grand grand multiparous women 8.6 ± 1.5,
8.9 ± 1.2 and 9.3 ± 0.9, 9.5 ± 1.1 (assessment and intervention groups, respectively) were higher as
compared to other parities. Regarding to the neonatal outcome the results revealed that there were
slightly higher rate of meconium stained amniotic fluid, in the assessment group as compared to
the intervention group with no statistically significant differences between the two groups. The
study concluded that' the grand grand multiparity carries the risk of maternal hypertension and
diabetes mellitus, which often leads to, induced labor or operative deliveries and placental
disorders.