ADOLECENT PREGNANCY, ELDERLY

PRIMIGRAVIDA, GRAND MULTIPARA -

assignment

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.   
     Younger age
     Poor school performance
     Economic disadvantages
     Single or teen parents

Possible Complications
     Adolescent pregnancy is associated with higher rates of illness with
higher rates illness and death for both the mother and infant.
     Death from violence is the second leading cause of death during
pregnancy for teens, and its higher in teens than in any other group.
     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
     Infants born to teens are 2-6 times more likely to have low birth weight
babies.
     Pre maturity and intra-uterine growth retardation.

Management
     All options made available to the pregnant teen should be considered
carefully including abortions, adoption and raising the child with
community or family support.
     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.
     Early and adequate prenatal care, throughout a programme the
specialities in teenage pregnancies ensures a health is baby.
     Adequate nutrition can be encouraged through education and
community resources.
     Appropriate exercise and adequate sleep should also be emphasized.
     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.
      Abstinence education programmes encourages young people to wait to
have sex until marriage or until they are mature enough to handle sexual
activity.
     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.
     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;
     One with high fecundity: A women married late but conceives soon after.
     One with low fecundity: Women married early but conceives long after
marriage.

Complications
          There is increased incidence of
     Abortion
     Pre-eclampsia
     Abruption placental because of pre-eclampsia and folic acid deficiency.
     Uterine firbroid
     Tendency of post maturity
     Intra uterine growth restriction

During Labour
          There is increased incidence of
     Preterm labour
     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
     Maternal and fetal distress appears early.
     Increased caesarean delivery

Fetal Risks
     Preterm birth and prematurity either introgenic or spontaneous
     IUGR
     Fetal congenital malformations

Prognosis
     The maternal morbidity is high
     The perinatal mortality is increased due to prematurity, increased
congenital malformation and operative interference.

Management
     Pre-conceptional counseling should be done.
     They require metaulous antenatal supervision
The following principles should be followed;
     Results of induction is unsatisfactory and such as caesarean section is a
preferred alternative.
     Prenatal diagnosis and sonography are done to excluded fetal genetic
anomaly.
     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
     Abortion
     Inherent obstetric hazards like;
o       Malpresentation
o       Multiple pregnancy
o       Placenta praevia
     Medical disorders such as anaemia hypertension, haemorrhoids and
varicose veins etc.
     Prematurity

Labour
     Cord prolapse
     Cephalopelvic disorders
     Obstructed labour
     Rupture uterus
     Post partum haemorrhage
     Shock
     Operative interference because of complications
 Puerperium
     Increased morbidity due to intranatal hazards
     Sub involution
     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.
     Pelvic assessment should be done as a routine.
     Presentations and positions are to be checked
     Undue delay in progress should be viewed with concern.
     To remain vigilant against PPH.

CONCLUSION

          There are many different kinds of teen pregnancy, pregnancy

prevention programme.

     Abstienence education programmes

     Knowledge based programmes
     Clinic focused programmes
     Peer counselling programmes
 BIBLIOGRAPHY

     A Textbook of Obstetrics and Gynecological Nursing

By: B.T.Basavantappa

     A Textbook of Obstetrics

By: D.C.Dutta