A multigravida is a term used in obstetrics to categorize a person who has been pregnant two or more times. This classification is a foundational component of a patient’s obstetric history, providing healthcare providers with insight into a patient’s physiological status and potential risks in the current pregnancy. The term focuses only on the number of times a pregnancy has occurred, regardless of the outcomes or number of deliveries.
Understanding Gravidity and Parity Terminology
The terms “gravidity” and “parity” form a system that documents a patient’s reproductive history. Gravidity refers to the total number of times a person has been pregnant, including the current pregnancy and any resulting in miscarriage, abortion, or stillbirth. A multigravida is pregnant for at least the second time, while a “primigravida” is in their first pregnancy, and a “nulligravida” has never been pregnant.
Parity, or “para,” relates to the number of times a person has given birth to a fetus that reached a viable gestational age, typically defined as 20 weeks or more. This count includes both live births and stillbirths, but a multiple gestation, like twins, counts as one single parous event. The distinction is important because a multigravida (two or more pregnancies) may still be nulliparous (zero births past 20 weeks) if all previous pregnancies ended before viability.
Physiological and Experiential Differences in Subsequent Pregnancies
A multigravida experiences several differences in subsequent pregnancies compared to a first-time pregnancy. One common change is the earlier perception of fetal movement, known as quickening. While a primigravida notices these first flutters around 20 weeks of gestation, a multigravida may recognize them as early as 16 weeks. This earlier recognition occurs because the uterine muscles are more relaxed from previous stretching, and the patient is familiar with the subtle sensation.
The abdomen also begins to show earlier in a multigravida patient due to the decreased resistance of the abdominal muscles and ligaments. These tissues have been stretched during prior pregnancies and do not hold the enlarging uterus as firmly as they did the first time. The uterus tends to rise out of the pelvis and become an abdominal organ sooner in subsequent pregnancies.
The most significant physiological difference occurs during labor and delivery, which is shorter for a multigravida. The cervix and lower uterine segment have been conditioned by previous deliveries, leading to a faster rate of dilation during the active phase of the first stage of labor. For a first-time parent, the active phase can last an average of 4 to 8 hours, but for a multigravida, this phase commonly lasts between 2 to 5 hours.
This accelerated process continues into the second stage, or pushing phase. This stage can be completed in as little as 5 to 60 minutes in a multigravida, compared to a longer duration for a primigravida.
Specific Monitoring and Risk Assessment for Multigravida Patients
The management of a multigravida patient involves specific risk assessments influenced by their past obstetric events. A history of prior cesarean delivery makes the patient a candidate for a trial of labor after cesarean (TOLAC) or a vaginal birth after cesarean (VBAC). This choice requires careful monitoring due to the risk of uterine rupture along the old scar, a risk that increases with the number of prior cesareans.
Prior pregnancies and uterine surgeries also increase the risk for certain placental complications. The presence of a scarred uterus, particularly from multiple cesarean deliveries, elevates the likelihood of the placenta implanting abnormally, such as placenta previa or placenta accreta. Placenta accreta, where the placenta attaches too deeply into the uterine wall, becomes a greater concern with each successive cesarean. Monitoring for these conditions involves specialized ultrasound surveillance during the second and third trimesters.