Archives of Gynecology and Obstetrics

, Volume 270, Issue 1, pp 21–24 | Cite as

Vaginal birth after cesarean section in grand multiparous women

  • Tarik Y. Yamani ZamzamiEmail author
Original Article



To determine the rate, delivery outcome and safety of attempted vaginal birth after cesarean section (VBAC) in grand multiparous women (para 6 or more).


This is a retrospective case-control study, performed at King Abdulaziz university hospital, the charts of 405 grand multiparous women with previous caesarean section were reviewed to determine rate and delivery outcome of attempted VBAC. The outcome of 217 VBAC in grand multiparous women was compared to the outcome of 217 VBAC in multiparous women (para 2–5) during the same period.


The rate of VBAC in grand multiparous women was 53.6%. One hundred-seventy five (80.7%) grand multiparous women were delivered vaginally compared to 170 (78.3%) in multiparous women, this was not statistically significant difference. Sixteen (7.4%) grand multiparous women need labor augmentation with oxytocin, while 34 (16%) in multiparous women, this was statistically significant difference (P value 0.005). The labor duration was 6.4±3.5 h in grand multiparous women compared to 9.0±4.3 h in multiparous women, and was also statistically significant difference (P value 0.001). The fetal weight, Apgar scores, postpartum hemorrhage, fever and number of hospital days in the two groups, were not statistically significant differences. In the control multiparous women there was one uterine rupture, two uterine dehiscence, and one stillbirth due to placental abruption.


VBAC in grand multiparous women is common practice, safe and efficacious. High parity in association with vaginal deliveries is good prognostic factor and also can predict successful VBAC outcome. However, further studies are needed to confirm our findings.


Grand multiparous Success rate Vaginal birth after cesarean section (VBAC) outcome 


  1. 1.
    American College of Obstetricians and Gynecologists (1996) Rate of vaginal births after cesarean delivery. ACOG committee opinion no. 179. ACOG, Washington DCGoogle Scholar
  2. 2.
    American College of Obstetricians and Gynecologists (1999) Vaginal birth after previous cesarean birth. ACOG practice bulletin no. 5, July 1999. ACOG, Washington DCGoogle Scholar
  3. 3.
    Dyack C, Hughes PF, Simbakalia JB (1996) Vaginal birth after caesarean section in the grand multipara with a previous lower segment scar. Int J Gynecol Obstet 55:167–168CrossRefGoogle Scholar
  4. 4.
    Evaldson GR (1990) The grand multipara in modern obstetrics. Gynecol Obstet Invest 30:217–223PubMedGoogle Scholar
  5. 5.
    Fayed HM, Abid SF, Stevens B (1993) Risk factors in extreme grand multiparity. Int J Gynecol Obstet 41:17—22Google Scholar
  6. 6.
    Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM (1990) Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 76:750–754PubMedGoogle Scholar
  7. 7.
    Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T (2001) Failed vaginal birth after a cesarean section: how risky is it? Am J Obstet Gynecol 184:1365–1371; discussion 1371–1373CrossRefPubMedGoogle Scholar
  8. 8.
    King PA, Duthie SJ, Ma HK (1991) Grand multiparity: a reappraisal of the risks. Int J Gynecol Obstet 36:13–16Google Scholar
  9. 9.
    Leung AS, Farmer RM, Leung EK, Medearis AL, Paul RH (1993) Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study. Am J Obstet Gynecol 168:1358–1362PubMedGoogle Scholar
  10. 10.
    McMahon MJ, Luther ER, Bowes WA, Olshan AF (1996) Comparison of a trial of labor with an elective second cesarean section. N Engl J Med 335:689–695CrossRefPubMedGoogle Scholar
  11. 11.
    Miller DA, Diaz FG, Paul RH (1994) Vaginal birth after cesarean: a 10-year experience. Obstet Gynecol 84:255–258PubMedGoogle Scholar
  12. 12.
    Norman P (1995) Vaginal birth after caesarean section. Lancet 345:142PubMedGoogle Scholar
  13. 13.
    Sipilia P, Von Wendt L, Hartikainen-Sorri AL (1990) The grand multipara—still an obstetric challenge? Arch Gynecol Obstet 247:187–195PubMedGoogle Scholar
  14. 14.
    Stone J, Lockwood CJ, Berkowitz GS, Lynch L, Alvarez M, Lapinski RH, Berkowitz RL (1992) Morbidity of failed labor in patients with prior cesarean section. Am J Obstet Gynecol 167:1513–1517PubMedGoogle Scholar
  15. 15.
    Toohey JS, Keegan KA, Morgan MA, Francis J, Task S, deVeciana M (1995) The "dangerous multipara": fact or fiction. Am J Obstet Gynecol 172:683–686PubMedGoogle Scholar
  16. 16.
    Zelop CM, Shipp TM, Repke JT, Cohen A, Lieberman E (2000) Effect of previous vaginal delivery on the risk of uterine rupture during a subsequent trial of labor. Am J Obstet Gynecol 183:1184–1186CrossRefPubMedGoogle Scholar
  17. 17.
    Ziel HA (1962) Grand multiparity—its obstetric complications. Am J Obstet Gynecol 84:1427-1441Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyKing Abdulaziz University HospitalJeddahKingdom of Saudi Arabia

Personalised recommendations