OBSTETRICS

Gravidity and Parity

Definitions
Implications in Risk Assessment
Authored by Dr Colin Tidy, Reviewed by Dr Jacqueline Payne | Last edited 21 Jan 2019
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The shorthand system of describing gravidity and parity has evolved

based on local obstetric traditions; it may vary slightly between different
communities and this can cause confusion.

Definitions
In the UK:

Gravidity is defined as the number of times that a woman has been

pregnant.

Parity is defined as the number of times that she has given birth to a
fetus with a gestational age of 24 weeks or more, regardless of whether
the child was born alive or was stillborn.

For example, a woman who is described as 'gravida 2, para 2 (sometimes

abbreviated to G2 P2) has had two pregnancies and two deliveries after
24 weeks, and a woman who is described as 'gravida 2, para 0' (G2 P0)
has had two pregnancies, neither of which survived to a gestational age
of 24 weeks.

If they are both currently pregnant again, these women would have the
obstetric history of G3 P2 and G3 P0 respectively. Sometimes a suffix is
added to indicate the number of miscarriages or terminations a woman
has had. So if the second woman had had two miscarriages, it could be
annotated G3 P0+2.

A nulliparous woman (nullip) has not given birth previously (regardless

of outcome).

A primagravida is in her first pregnancy.

A primiparous woman has given birth once. The term 'primip' is often
used interchangeably with primagravida, although technically incorrect,
as a woman does not become primiparous until she has delivered her
baby.

A multigravida has been pregnant more than once.

A multiparous woman (multip) has given birth more than once.

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.

A grand multigravida has been pregnant five times or more.

 A great grand multipara has delivered seven or more infants beyond 24
weeks of gestation.

Multiple pregnancies present a problem: a multiple gestation counts as a

single event and a multiple birth should be interpreted as a single parous
event, although this remains contentious. In a survey, only 20% of British
midwives and obstetricians recognised a twin delivery as a single parous
event - G1 P1 rather than G1 P2, revealing the potential lack of
standardisation in our documentation[1].

A more elaborate coding system used elsewhere, including America, is

GTPAL (G = gravidity, T = term deliveries, P = preterm deliveries, A =
abortions or miscarriages, L = live births).

Epidemiology
The current total fertility rate (the average number of children a woman
would have if she experienced the fertility rate of a particular year for
her entire childbearing years) stands at 1.91 (2012 figures)[2].

Women are commencing their childbearing later and having fewer

children in total. Women born in 1982 have had slightly fewer children
(average 1.02) by their 30th birthday than women born in 1967 who had
an average of 1.16 children by the same age.

More women remain childless (19% of women born in 1967 compared

to 11% of those born in 1940). One in ten women born in 1967 had four
or more children, compared with nearly one in five women born in 1940.
The number of higher order grand multips has fallen significantly.

Relationship of gravidity and

parity to risk in pregnancy
Obstetric histories should always record parity, gravidity and outcomes
of all previous pregnancies because:
 Outcomes of previous pregnancies give some indication of the likely
outcome and degree of risk with the current pregnancy.

The number of previous pregnancies and deliveries will also influence

the risks associated with the current pregnancy.

What is considered normal labour varies according to parity:

Normal labour in a primagravida is significantly different to normal
labour in multiparous women, as physiologically the uterus is a less
efficient organ, contractions may be poorly coordinated or hypotonic.
The average first stage in a primagravida is significantly slower than in a
multiparous woman (primarily due to the rate of cervical dilation).
Therefore, progress is expected to be slower but delay longer than
expected should prompt augmentation in managed labour.

Interestingly, grand multips have a longer latent phase of labour than

either nulliparous or lower-parity multiparous women but then begin to
dilate more rapidly. After 6 cm dilation, partogram curves for lower
parity multips and grand multips are indistinguishable. Progress of
labour does not appear to continue to improve with additional
childbearing.

Risks associated with

nulliparity/primagravidae
Higher risk of developing pre-eclampsia (relative risk 2.1 with
confidence interval 1.9-2.4)[3].

Delayed first stage of labour, although this could be considered normal

in a primagravida.

Dystocia (or difficult labour) was diagnosed in 37% of primagravidae in

one Danish study[4]. Maternal age is an independent risk factor for
dystocia, regardless of parity[5].

Risks associated with grand multiparity

Abnormal fetal presentation.

Precipitate and preterm delivery although higher age is more

significant[6, 7].
 Uterine atony.

Placenta praevia.

Uterine rupture.

Amniotic fluid embolism.

Postpartum haemorrhage.

Stress incontinence and urinary urgency symptoms[8].

What is a high-risk pregnancy?

Risk equates to factors that increase likelihood of harm to mother or
baby. There is no universally accepted definition of a 'high-risk'
pregnancy and antenatal 'risk' screening cannot identify every
pregnancy/labour that will run into complications. Usually risk factors
are combined and weighted to try to match an appropriate level of
medical care and intervention to a more risky pregnancy to attempt to
reduce the chances of a poor outcome.

Confounding variables[9]
Increased parity is often associated with:

Increasing maternal age - particularly with levator ani dysfunction[10].

Lower socio-economic and educational status.

Poorer prenatal care (more likely to be late bookers and poor attenders).

Smoking and alcohol consumption.

Higher body mass index (BMI).

Higher rates of gestational diabetes.

It is not always possible to disassociate the various risk factors

attributable to each factor.

Management
Primigravidae
Provide:

Good antenatal care with particular vigilance to early warning signs of

pre-eclamptic toxaemia (PET). The National Institute for Health and
Care Excellence (NICE) recommends nullips with uncomplicated
pregnancies should have 10 routine antenatal appointments (versus 7 in
parous women)[11].

Good antenatal and parenting education, support during labour and pain
control (if desired) are especially important in a first pregnancy, as
anxiety levels are likely to be high.

Where there is delay in the first stage of labour in a primagravida, active

management is with artificial rupture of membranes and/or oxytocin to
augment labour.

The second stage of labour can be allowed to continue for longer than
the traditional time associated with multips, as long as fetal monitoring
is satisfactory and there is ongoing fetal descent.

Grand multigravidae
It is usually appropriate to book for delivery in a specialised unit.
Consider:

Iron and folate prophylaxis.

A plan for the care of existing children during admission.

Vigilance for abnormal fetal presentations from 36 weeks onwards.

Planning for possible rapid labour and delivery.

Monitoring strength of contractions and fetal presentation during

delivery.

Planning for the possibility of postpartum haemorrhage.

Good physiotherapy and postnatal follow-up for urogynaecological

problems.
 F U RT H E R R E A D I N G A N D R E F E R E N C E S

1. Opara EI, Zaidi J; The interpretation and clinical application of the word 'parity':
a survey. BJOG. 2007 Oct114(10):1295-7.

2. Total fertility rate; Office for National Statistics

3. Bartsch E, Medcalf KE, Park AL, et al; Clinical risk factors for pre-eclampsia
determined in early pregnancy: systematic review and meta-analysis of large
cohort studies. BMJ. 2016 Apr 19353:i1753. doi: 10.1136/bmj.i1753.

4. Kjaergaard H, Olsen J, Ottesen B, et al; Incidence and outcomes of dystocia in

the active phase of labor in term nulliparous women with spontaneous labor
onset. Acta Obstet Gynecol Scand. 200988(4):402-7.

5. Waldenstrom U, Ekeus C; Risk of labor dystocia increases with maternal age

irrespective of parity: a population-based register study. Acta Obstet Gynecol
Scand. 2017 Sep96(9):1063-1069. doi: 10.1111/aogs.13167. Epub 2017 Jun 20.

6. Hu CY, Li FL, Jiang W, et al; Pre-Pregnancy Health Status and Risk of Preterm
Birth: A Large, Chinese, Rural, Population-Based Study. Med Sci Monit. 2018 Jul
824:4718-4727. doi: 10.12659/MSM.908548.

7. Waldenstrom U, Cnattingius S, Vixner L, et al; Advanced maternal age increases

the risk of very preterm birth, irrespective of parity: a population-based register
study. BJOG. 2017 Jul124(8):1235-1244. doi: 10.1111/1471-0528.14368. Epub
2016 Oct 21.

8. Handa VL, Harvey L, Fox HE, et al; Parity and route of delivery: does cesarean
delivery reduce bladder symptoms later in life? Am J Obstet Gynecol. 2004 Aug

9. Roman H, Robillard PY, Verspyck E, et al; Obstetric and neonatal outcomes in

grand multiparity. Obstet Gynecol. 2004 Jun103(6):1294-9.

10. Waldenstrom U, Ekeus C; Risk of obstetric anal sphincter injury increases with
maternal age irrespective of parity: a population-based register study. BMC
Pregnancy Childbirth. 2017 Sep 1517(1):306. doi: 10.1186/s12884-017-1473-
7.
11. Antenatal care for uncomplicated pregnancies; NICE Clinical Guideline (March
2008 - updated February 2019)

ARTICLE INFORMATION

Last Reviewed 21 January 2019

Next Review 20 January 2024

Document ID 1324 (v27)

Author Dr Colin Tidy

Peer reviewer Dr Jacqueline Payne

The information on this page is written and peer

reviewed by qualified clinicians.

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