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Transcript
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

Associated socio-economic factors
P REGNANCY W EAR


AND
T EAR
Nutrient depletion

Iron drain from pregnancy and lactation

Calcium and others
Uterine Damage

Myometrial thinning and fibrosis →

Dysfunctional labour


Both hypertonic and hypotonic uterine activity

Unpredictable response to oxytocic agents

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

Precipitate deliveries and genital tract injury

Uterovaginal prolapse and urinary incontinence
Other Sites

Problems with pelvic stability

Back problems

Varicose veins and Haemorrhoids
Metabolic

Increasing birthweight due to a variety of causes

Sometimes increasing maternal weight
T HE E FFECTS OF I NCREASING M ATERNAL
A GE


Increased risk miscarriage and aneuploidy

Increasing age of eggs

Risk of miscarriage is 1:10 at 20 but 1:3 at 40
Increased rates of multiple pregnancy


An effect of increasing FSH which ripens >1 follicle
Many Diseases

Diabetes

Hypertension

Coronary artery disease
A SSOCIATED S OCIO -E CONOMIC FACTORS

Poverty

Illiteracy

Smoking, alcohol & drug abuse

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



Precipitate delivery

Uterine atony
Obstetric Haemorrhage

Placenta previa

PPH
Uterine Rupture
M ANAGEMENT OF THE G RANDE
M ULTIPARA

Take a careful history – past obstetric history

Optimise HB and iron stores

Increased surveillance and screening in pregnancy


Check carefully presentation at each visit >36 weeks

“Watch and wait” in labour

Use oxytocics with caution

Active management of the 3rd stage of labour
Prevention of High Parity

Family Planning

Starts with the first pregnancy!
A NY Q UESTIONS OR C OMMENTS ?