ADOLECENT PREGNANCY, ELDERLY PRIMIGRAVIDA, GRAND MULTIPARA

 

INTRODUCTION

 

          Women having their first pregnancy at or above the age of 30 years are called elderly primigravida.

 

          A grand multipara relates to a pregnant women who has got previous four or more viable births.

ADOLESCENT PREGNANCY

 

Definition

          Adolescent pregnancy in girls age in or younger. The scope of adolescent pregnancy is enormous, the mean age of menarche is around 12 years. Forty two percent of girls and 64% of boys are sexually active by age 18 (Annamma Jacobe).

 

Causes

          Adolescent pregnancy and babies born to adolescent have dropped since reaching in all time high in 1990. There is mostly due to the increase use of condoms.   

Ø     Younger age

Ø     Poor school performance

Ø     Economic disadvantages

Ø     Single or teen parents

 

Possible Complications

Ø     Adolescent pregnancy is associated with higher rates of illness with higher rates illness and death for both the mother and infant.

Ø     Death from violence is the second leading cause of death during pregnancy for teens, and its higher in teens than in any other group.

Ø     Pregnant teens are at much higher risk of having serious complications such as

o       Placenta previa

o       Pregnancy induced hypertension

o       Premature delivery

o       Significant anemia

o       Toxemia

Ø     Infants born to teens are 2-6 times more likely to have low birth weight babies.

Ø     Pre maturity and intra-uterine growth retardation.

 

Management

Ø     All options made available to the pregnant teen should be considered carefully including abortions, adoption and raising the child with community or family support.

Ø     Discussion with the teen may require several visits with a health care provides to explain all options in a non-judge mental manner and involve the parents as the father of the baby as appropriate.

Ø     Early and adequate prenatal care, throughout a programme the specialities in teenage pregnancies ensures a health is baby.

Ø     Adequate nutrition can be encouraged through education and community resources.

Ø     Appropriate exercise and adequate sleep should also be emphasized.

Ø     Contraception information and services are important after delivery to prevent teens from becoming pregnant again.

 

Prevention

          There are many different kinds of teen pregnancy prevention programmes.

Ø      Abstinence education programmes encourages young people to wait to have sex until marriage or until they are mature enough to handle sexual activity.

Ø     Knowledge based programmes focus on teaching kinds about their bodies it also provides detailed information about birth control and how to prevent sexually transmitted infections.

Ø     Peer counseling programmes, typically involve older teens, who encourage other kids to resist peer and social pressures to have sex.

ELDERLY PRIMIGRAVIDA

 

Definition

          Women having their first pregnancy at or about the age of 30 years are called elderly primigravidae.

 

Incidence

          Two groups are there;

Ø     One with high fecundity: A women married late but conceives soon after.

Ø     One with low fecundity: Women married early but conceives long after marriage.

 

Complications

          There is increased incidence of

Ø     Abortion

Ø     Pre-eclampsia

Ø     Abruption placental because of pre-eclampsia and folic acid deficiency.

Ø     Uterine firbroid

Ø     Tendency of post maturity

Ø     Intra uterine growth restriction

 

During Labour

          There is increased incidence of

Ø     Preterm labour

Ø     Prolonged labour due to

o       Uterine inertia caused by anxiety or malposition.

o       Impaired joint mobility

o       Inelasticity of the soft tissues of the birth canal

Ø     Maternal and fetal distress appears early.

Ø     Increased caesarean delivery

 

Fetal Risks

Ø     Preterm birth and prematurity either introgenic or spontaneous

Ø     IUGR

Ø     Fetal congenital malformations

 

Prognosis

Ø     The maternal morbidity is high

Ø     The perinatal mortality is increased due to prematurity, increased congenital malformation and operative interference.

 

Management

Ø     Pre-conceptional counseling should be done.

Ø     They require metaulous antenatal supervision

The following principles should be followed;

Ø     Results of induction is unsatisfactory and such as caesarean section is a preferred alternative.

Ø     Prenatal diagnosis and sonography are done to excluded fetal genetic anomaly.

Ø     Addition of another complication should be viewed with concern.

 

GRAND MULTIPARA

 

Definition

          A grand multipara relates to a pregnant mother who has got previous mother who has got previous four or more viable births.

 

Incidence

          The incidence has been gradually declining over the couple of decades due to acceptance about one-tenth of the hospital populations and accounts for 1/3 of the maternal death in the developing countries.

 

Complications

Pregnancy

Ø     Abortion

Ø     Inherent obstetric hazards like;

o       Malpresentation

o       Multiple pregnancy

o       Placenta praevia

Ø     Medical disorders such as anaemia hypertension, haemorrhoids and varicose veins etc.

Ø     Prematurity

 

Labour

Ø     Cord prolapse

Ø     Cephalopelvic disorders

Ø     Obstructed labour

Ø     Rupture uterus

Ø     Post partum haemorrhage

Ø     Shock

Ø     Operative interference because of complications

 

Puerperium

Ø     Increased morbidity due to intranatal hazards

Ø     Sub involution

Ø     Failing lactation

 

Management

          The cases are considered as ‘high risk’ as such they require adequate antenatal care and should have a mandatory hospital delivery. During, the following guidelines are prescribed.

Ø     Pelvic assessment should be done as a routine.

Ø     Presentations and positions are to be checked

Ø     Undue delay in progress should be viewed with concern.

Ø     To remain vigilant against PPH.

CONCLUSION

 

 

          There are many different kinds of teen pregnancy, pregnancy prevention programme.

 

Ø     Abstienence education programmes

Ø     Knowledge based programmes

Ø     Clinic focused programmes

Ø     Peer counselling programmes

BIBLIOGRAPHY

 

 

Ø     A Textbook of Obstetrics and Gynecological Nursing

By: B.T.Basavantappa

 

Ø     A Textbook of Obstetrics

By: D.C.Dutta