ELDERLY PRIMI GRAVIDA & GRAND MULTI PARApptx

DESCRIBES ABOUT ELDERLY PRIMI GRAVIDA AND GRAND MULTI PARA

1. ELDERLY PRIMIGRAVIDAE MRS U SREEVIDYA PROFESSOR

2. INTRODUCTION The elderly primigravida is a woman going through her 1 st pregnancy at or over the age of 35years.This definition may be adopted in the developing countries, but it must be remembered that the reproductive activity of the women in developing countries starts at a much earlier age than that of the women in developed countries. Although the age limit is being raised from 35-40 years in India, Britain and other European countries , it may be wise to regard as an elderly primigravida, any women who is pregnant for the 1 st time at the age of 30years or more is elderly primi gravida.

3. DEFINITION Women having their first pregnancy at or above the age of 30 years called elderly primigravidae. Waters and Wager 1  coined the term "elderly primigravida" to describe  a woman who is 35 years of age or older and pregnant for the first time .

4. CATEGORIES: Elderly primi gravidae are divided into two categories; 1. High Fecundity: A woman married late but conceives soon after marriage 2. Low Fecundity: Woman married early but conceives long after marriage

5. COMPLICATIONS

6. DURING PREGNANCY Abortion Pre-eclampsia associated with hypertension Abruptio placenta- due to pre-eclampsia and folic acid deficiency Uterine fibroid Medical complications such as Hypertension (P.I.H), Diabetes Mellitus and Organic Heart Disease Post maturity Intra-uterine growth restriction (IUGR)

7. DURING LABOUR Pre mature labour Prolonged labour Maternal and foetal distress Increased operative interference Retained placenta

8. DURING PUERPERIUM Increased morbidity due to operative interference Failing lactation

9. MANAGEMENT The mother is considered as “ High Risk Pregnancy” Meticulous antenatal supervision is needed Labor is usually longer in elderly primigravida than in the multipara Posterior positions of the occiput are very common. Abnormal uterine action may complicate labour Elderly primigravidae requires obstetric intervention because of the rigid perineum and prolonged labour. The neonatal morbidity and mortality are increased because of prematurity, prolonged labour, increased risk of congenital anomalies like (Mangolism, hydrocephalus, anencephaly etc..). This is all due to increasing maternal age.

10. Cont. viii. There should be a hospital delivery ix. If induction is unsatisfactory, cesarean section is done x. Sonography is done to detect bony malformation of the fetus, if it is, then only LSCS is done xi. Check for additional complications

11. GRAND MULTIPARA

12. INTRODUCTION A grand multipara relates to a pregnant mother who has got previous four or more viable births . The incidence has been gradually declining over the couple of decades due to acceptance of small family norm, but it still constitutes to about one-tenth of the hospital population and accounts for one-third of the maternal deaths in the developing countries.

13. DEFINITION A grand multipara relates to a pregnant mother who has got previous four or more viable births. -D.C.Dutta A grand multipara is a pregnant woman who has got previous four or more viable births. - Dr. Shally Magon

14. COMPLICATIONS

15. DURING PREGNANCY 1. Abortion 2. Obstetric hazards like Mal presentation Multiple pregnancy Placenta previa 3. Medical Disorders i.e., Anaemia Hypertension Cardio vascular complications 4. Pre maturity

16. DURING LABOUR Cord prolapse Cephalo pelvic disproportion (CPD) Obstructed labour Rupture uterus Postpartum hemorrhage Shock Operative interference Precipitate labour

17. DURING PUERPERIUM Increased morbidity due to intranatal hazards Sub involution Failing lactation

18. MANAGEMENT The cases are considered as “high risk”. As such they require adequate antenatal care and should have a mandatory hospital delivery. During labor, the following guidelines are prescribed— Pelvic assessment should be done as a routine Presentation and position are to be checked Undue delay in progress should be viewed with concern To remain vigilant against PPH

19. Cont. 3. Facilities for dealing with complicated deliveries They require adequate antenatal care Delivery should be done routinely Monitoring of vital parameters including pain Check foetal presentation and position Monitoring of further complications of both the mother and the baby