Transcript High Parity Pregnancy (The Grande Multipara)

H IGH PARITY P REGNANCY
(T HE G RANDE M ULTIPARA )
T HE E FFECT OF PARITY ON
M ATERNAL M ORTALITY
R EASONS FOR R ISING M ORTALITY
R ISK WITH I NCREASING PARITY

“Wear and Tear” from prior pregnancies

Increasing Maternal Age
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Associated socio-economic factors
P REGNANCY W EAR
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
AND
T EAR
Nutrient depletion

Iron drain from pregnancy and lactation
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Calcium and others
Uterine Damage
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Myometrial thinning and fibrosis →

Dysfunctional labour


Both hypertonic and hypotonic uterine activity

Unpredictable response to oxytocic agents
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Risk of uterine rupture
Endometrial thinning and morbid adherence of the
placenta → Placenta previa and also

Retained placenta and PPH
P REGNANCY W EAR



AND
T EAR (2)
Abdominal Wall, Genital Tract and Pelvic Floor

Spherical uterus → unstable lie and malpresentation
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Precipitate deliveries and genital tract injury
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Uterovaginal prolapse and urinary incontinence
Other Sites
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Problems with pelvic stability
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Back problems
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Varicose veins and Haemorrhoids
Metabolic
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Increasing birthweight due to a variety of causes
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Sometimes increasing maternal weight
T HE E FFECTS OF I NCREASING M ATERNAL
A GE
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Increased risk miscarriage and aneuploidy
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Increasing age of eggs
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Risk of miscarriage is 1:10 at 20 but 1:3 at 40
Increased rates of multiple pregnancy
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An effect of increasing FSH which ripens >1 follicle
Many Diseases
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Diabetes
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Hypertension
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Coronary artery disease
A SSOCIATED S OCIO -E CONOMIC FACTORS

Poverty

Illiteracy

Smoking, alcohol & drug abuse
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Poor Access to Health Care

War and Famine

Domestic abuse etc.
C OMMON P ROBLEMS
OF
H IGH PARITY

Unstable lie and malpresentation

Dysfunctional Labour
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Precipitate delivery
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Uterine atony
Obstetric Haemorrhage
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Placenta previa
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PPH
Uterine Rupture
M ANAGEMENT OF THE G RANDE
M ULTIPARA

Take a careful history – past obstetric history
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Optimise HB and iron stores
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Increased surveillance and screening in pregnancy


Check carefully presentation at each visit >36 weeks
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“Watch and wait” in labour
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Use oxytocics with caution
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Active management of the 3rd stage of labour
Prevention of High Parity
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Family Planning

Starts with the first pregnancy!
A NY Q UESTIONS OR C OMMENTS ?