Is Grand Multiparity an independent risk factor for blood transfusion?

Abstract Background The relation between grand multiparity and poor pregnancy outcome, especially post-partum hemorrhage and blood transfusion has not been consistent. Some studies found an association between maternal and neonatal mortality more recent literature is less clear about the risks.Objectives We aimed to determine the association of grand multiparity with the need for post-partum blood transfusion.Study Design: We conducted a retrospective cohort study in a single tertiary university-affiliated medical center between 2011 and 2019. All women were categorized into one of three groups based on the number of previous deliveries: (a) nulliparous (no previous delivery), (b) multiparous (1–4 previous deliveries), (c) grand multiparous (≥ 5 previous deliveries). We compared the demographic, clinical, and pregnancy outcomes of the study groups. The primary outcome was the need for red blood cell transfusion during the index admission.Results Overall, during the study period there were 87,343 deliveries in our center. Among the study population, 36,777 (42.1%) were nulliparous, 49,072 (56.1%) were multipara and 1,494 (1.7%) were grand multiparous. Overall, 1602 women (1.8%) were treated with RBC transfusion. Cesarean delivery, macrosomia, preterm delivery, multiple gestations, antenatal anemia, thrombocytopenia, intrauterine fetal death (IUFD), and prolonged second or third stage of labor, were more prevalent among women who were treated with RBC transfusion. After controlling for potential confounders, including maternal age, preterm delivery, IUFD, mode of delivery, and antenatal thrombocytopenia grand multiparity was found to be an independent protective factor for RBC transfusion [OR = 0.2 (0.007–0.56), p-value = 0.002]Conclusion After controlling for cofounders, grand multiparity alone, after controlling for cofounders, is not associated with postpartum blood transfusion.