Obstetrics Simplified - Diaa M. EI-Mowafi
High Risk Pregnancy
Definition
It is the pregnancy in which the mother foetus and / or newborn are at risk of morbidity or mortality during pregnancy, labour and/ or postpartum.
Incidence
About 20% of all pregnancies.
Causes
Maternal factors
- Age: below 16 years or above 35 years particularly if the patient is primigravida.
- Grand multiparity: 5 or more previous deliveries.
- Habits: as heavy smoking, alcoholism or drug addiction.
- Bad obstetric history:
- Repeated abortion.
- Repeated preterm labour.
- Prolonged or difficult labour particularly if was ended by stillbirth or neonatal death.
- Operative delivery as caesarean section or forceps.
- History or current medical disorders:
- Hypertension.
- Diabetes.
- Cardiac.
- Renal.
- Pulmonary.
- Hepatic.
- Anaemia.
- Coagulation defects.
- Haemoglobinopathies.
- Serious infections as AIDS.
- History of surgery or trauma:
- Myomectomy.
- Metroplasty.
- Pelvic trauma.
Foetal factors
- Malpresentations and malpositions.
- Multiple pregnancy.
- Antepartum haemorrhage.
- Congenital anomalies.
- Premature rupture of membranes.
- Rh-isoimmunization.
- Intrauterine growth retardation.
- Macrosomia.
- Poly - or oligohydramnios.
- Post-term pregnancy.
Management
- Frequent antenatal visits.
- Management of the cause.
- Monitoring of foetal well-being (see later).
- Delivery in well - equipped hospital under senior staff supervision.
Elderly primigravida
Definition
Primigravida whose age is above 35 years.
Dangers
This woman is more liable to:
- Hypertension with pregnancy.
- Abruptio placentae.
- Higher incidence of fibroid with pregnancy.
- Post-term pregnancy.
- Uterine inertia and prolonged labour.
- Rigid perineum so instrumental deliveries are more needed.
- More caesarean section delivery as the foetus is precious.
The grand multipara
Definition
Woman who had 5 or more previous deliveries.
Dangers
This woman is more liable to:
- Anaemia.
- Hypertension with pregnancy.
- Diabetes.
- Placenta praevia.
- Pendulous abdomen.
- Malpresentation and malposition.
- Uterine inertia and prolonged labour.
- Instrumental delivery and caesarean section are more needed.
- Obstructed labour which may lead to rupture uterus due to:
- higher incidence of malpresentations and malpositions,
- pendulous abdomen,
- weak uterine muscles,
- some osteomalacic changes in the pelvis,
- larger sized baby,
- false sense of security due to previous normal deliveries.
- Postpartum haemorrhage.
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