High risk pregnancy is define as one in which the mother, fetus or newborn will be at increased risk of morbidity or mortality at or after birth. Baby weighing <2.5 kg or >4.5 kg. Very advanced maternal age (vAMA) was identified from data on the age group of the mother and defined as women who were 40 years or older at the time of delivery. Group I consistent of 100 women of parity five or more and group II consistent of 100 women were admitted during the same period with parity one to four. We're here to answer any questions you have about our services. 2. Discuss the effects of hypertension and diabetes on the maternal–placental–fetal complex. No Yes . Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size. Complications. Am J Obstet Gynecol 1962; 84: 1427. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg & prolonged labour. Recommended articles Citing articles (0) References. Is emergency blood available? Extension of an episiotomy. Brunner et al, in 1992 concluded that grand multi parity should be regarded as an obstetric risk factor, mainly because of the higher frequency of placental complication and with good obstetric care there should be no advice affects to the mother or newborn10. Grand multiparity - its obstetric complications. Data was collected through special proforma, neonatal follow up recorded was also entered in the same proforma. Our patient was not at particular risk for uterine rupture. Uterine inversion. Recommended articles Citing articles (0) References. Great grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=2.6, P<0.001), labour dystocia, second stage (OR=2.1, P<0.001), and perinatal mortality (OR=2.5, P<0.001). This essay may contain factual inaccuracies or out of date material. One year from 1st July 2008 to 31st March 2009 at Civil Hospital Karachi and 1st April 2009 to 30th June 2009 at Sheikh Zaid Women Hospital Larkana. Risk factors for PPH include grand multiparity and multiple gestation. Disclaimer: This work has been submitted by a university student. These cases were divided into two groups. Grand multiparity Thrombophilia ECV Domestic violence/assault Uterine rupture Bleeding (may be concealed) Sudden onset of constant sharp abdominal pain, however may be relatively painless in some cases. 2. Frequencies and percentages were computed for presentation of all categorical variables of the study including age, booking status, mode of delivery, pregnancy related complications, intrapartum and postpartum complications, maternal and fetal mortality, and birth weight. Assess the fetus/neonate for effects of tocolytic drugs. a. Rupture uterus was frequently changed in more recent literatures to delivery order of five or above.4, 5. Small-for-gestational-age infant (<5th centile). One GP I went to for an unrelated to pregnancy issue nearly died of shock when she found out I was having my 7th child at home! Uterine inversion is a rare but dramatic cause of uterine atony and haemorrhage. Malpresentations and nonegagement. Most often problems with the passageway are a result of pelvic abnormalities that interfere with the engagement, descent, and expulsion of the fetus. Management. This comparative, cohort study was conducted in largest hospital of Karachi to find out whether grand multi parity is risk factor for obstetrical complication when compare to low parity. 8- prolapsed umblical cord9- macrosomia10- suspected CPD11- prior classic uterine incision12- prior rupture of uterus13- pelvic structural deformities14- inability to adequetely monitor of FHR during labor15- multiple pregnancy 16- grand multiparity ( >= 5 previous pregnancies > 20 w) Contracted pelvis. Antibiotic prophylaxis give in the last hour? World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. * Shows statistically significant difference at p < 0.05. Examination starts with review of vital signs, particularly blood pressure, for signs of hypovolemia. Examination starts with review of vital signs, particularly blood pressure, for signs of hypovolemia. The grand multipara — maternal and neonatal complications. Antibiotic prophylaxis give in the last hour? Obstetrical complication are more in grand multiparae than the low parity women. Postpartum and Complications.ppt from NURS 4358 at Louisiana State University. If yes, There is adequate IV access? * Significant difference (Fisher’s exact test, p = 0.213). INDUCTION OF LABOUR DEFINITION Artificial stimulation of uterine contractions before spontaneous onset of labour with the purpose of accomplishing successful vaginal delivery INDICATIONS MATERNAL Preeclampsia, eclampsia PROM Postterm preg Abruptio placenta Chorioamnionitis Medical conditions-DM,Heart ds, Renal ds,Chr. Health And Social Care Mode of delivery was also recorded. Intra-amniotic infection (chorioamnionitis) Other causes of postpartum hemorrhage include. Preterm labour was defined as labour before 37 complete weeks gestation. Grand multiparity Thrombophilia ECV Domestic violence/assault Uterine rupture Bleeding (may be concealed) Sudden onset of constant sharp abdominal pain, however may be relatively painless in some cases. View 4. 11th May 2017 It is generally accepted that GMP is risk factor of obstetric complication but recently a few reports have appeared in the literature showing that this might be fiction rather than fact. Categorize intrapartum conditions that may result in complications for the newborn infant. Our academic experts are ready and waiting to assist with any writing project you may have. Precipitate and preterm delivery although higher age is more significant [6, 7]. BreechPresentation Lucy Pettit 2. To study the frequency of maternal and perinatal mortality associated with complications of grand multi parity. Subdural hemorrhage for the fetus may occur from the rapid release of pressure on the head. Grand multiparity (delivery of ≥ 5 viable fetuses) Uterine abnormalities. Grand multiparity (delivery of ≥ 5 viable fetuses) Relaxant anesthetics. Grand multiparae is relation to obstetric performance is labeled high risk. In our study the grand multipara were older then low parity women. Increased lumbar lordosis. Many investigators have reported association of LBW with grand multiparae. It is concluded from my study that antenatal complications like pregnancy induced hypertension, abruptio placenta, anaemia, malpresentation, Caesarean deliveries and perinatal mortality were more common in grand multiparae then the low parity group and multi parity is still a major obstetric hazards in our set up with higher incidence of complications. Am J Obstet Gynecol 1962; 84: 1427. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. In our study perinatal mortality was significantly increased in grand multi parity it mainly because of abruptio placenta, PIH, obstructed labour and preterm birth. Large-for-gestational-age infant (>95th centile). Premature rupture of membranes and prolapse of the cord. Grand multiparae is woman who has delivered five or more babies after 28 weeks, weighing more than 500 grams. Company Registration No: 4964706. Grand multi parity is the condition of giving birth after the 28th weeks of gestation, following 5 or more previous viable babies. Although number of placenta previa was increased in grand multi parity than low parity but not statistically significant. Bleeding from genital tract after 24 weeks gestation was taken as APH. Passageway abnormalities 1. Statistical significance was taken at p < 0.05. Malpresentations and nonegagement. 7.6.3 Management. Abdominal binder. Baby with a structural or chromosomal anomaly. This diagnosis should be made before labour begins, at the last prenatal visit before the birth. Risks associated with grand multiparity. Baby with a structural or chromosomal anomaly. CONCLUSION: Women with high birth order are at increased risk for adverse obstetric outcomes. Download images(. All work is written to order. Scribd is the world's largest social reading and publishing site. Placentae previa, preterm labour and twin pregnancy were insignificant between two groups (Table-3). Now customize the name of a clipboard to store your clips. Amniotic fluid embolism (AFE) is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and trigger an allergic reaction. Registered Data Controller No: Z1821391. Uterine atony is more common in grand multipara, young women and in home delivery. Obstet Gynecol, 8 (1987), p. 135. Subdural hemorrhage for the fetus may occur from the rapid release of pressure on the head. Grand multiparity Pregnancy Maternal outcome Grand multiparity is defined by the International Federation of Gynecology and Obstetrics (FIGO) as 5 deliveries or more [1]. we found 1 case of Ruptured uterus in each group, both these are patient were referred from private hospital, both were older age, both were mismanaged with syntocynon but low parity woman was survive and grand multiparous woman was die. One maternal death found in my study this unfortunate woman belong to low socioeconomic class, had obstructed labor due to macrosomic baby and mismanaged with syntocinon referred in state of shock despite of emergency laparotomy, blood transfusion, and resuscitation she could not survive because she was already anemic had bleed a lot and die due to cardiac failure. Uterine rupture. Large-for-gestational-age infant (>95th centile). Small-for-gestational-age infant (<5th centile). Short interpregnancy interval. Postpartum haemorrhage. prolonged labour, multiple pregnancy, big baby, polyhydramnios, grand multiparity, clotting dysfunction, PPH in the past). Grand multiparae is relation to obstetric performance is labeled high risk. Reference this. Management. Very high presenting part Maternal shock Contractions may stop Peritonism Likely to be abnormal FHR with acute fetal compromise If you continue browsing the site, you agree to the use of cookies on this website. This study shows that antenatal complication such as anemia was more common in grand multiparae. Passageway abnormalities 1. Problems in the pelvis or soft tissues of the reproductive tract. Amniotic fluid embolism (AFE) is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and trigger an allergic reaction. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Page L in her series of study has reported that same result. Stress incontinence and urinary urgency symptoms . Grand multiparity facilitates this kind of labor, or it can also happen after induction of labor by oxytocin or amniotomy. Intrapartum Care: Monitoring and management of the first stage of labour, Chapter 8 nursing care during labor and pain management, Intrapartum Care: Managing pain during labour, Management of abnormal labor & partograph, No public clipboards found for this slide. Previous stillbirth or neonatal death. If this stops the contractions, tocolytic therapy is not needed. Complications. Placenta accreta spectrum (including placenta increta, and perceta) Physical examination. (i.e. High risk pregnancy is define as one in which the mother, fetus or newborn will be at increased risk of morbidity or mortality at or after birth. No plagiarism, guaranteed! 3. It is therefore recommended that active management of the third stage of labour be offered to all women during childbirth, whenever a skilled provider is assisting with the delivery (1). Great-grand multipara refers to a woman who has had 10 or more viable pregnancies. After delivery, the patients were monitor for 24 hours for primary PPH which was taken as blood loss estimated to be more than 500ml after normal vaginal delivery and 1000ml after caesarean section. Munim et al, noted in her study PPH was three times more common in grand multiparae 4. 30/09/2004 Decrease maternal mortality 13 RISK FACTORS OF PPH GENITAL-TRAUMA In fact, the rate of induction of labor doubled between 1990 and 2006 and has continued to trend upwards. Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size. Looking for a flexible role? At the end of pregnancy Singleton pregnancy Booking status between two groups was statistically insignificant (p=0.344). 2. Toohey et al, Fayed et al, and Kaplan et al, addressed the obstetric performance of great grand multipara but they concoluded that such women were not a high risk group7,8,9. Sample selection was done according to the following inclusion and exclusion. Prolonged labour, uterine overdistension, grand multiparity, retained placental tissue or haematometria (abruption) may contribute to inadequate myometrial contraction. So, the age matched study should be done for the proper risk assessment. But in my study low birth weight was common in low parity as compare to grand multiparae. Solomon first introduced the term "grand multipara" or "dangerous multipara" in 1934 after observing that increasing parity was associated with an increased risk of pregnancy complications and maternal mortality increased steadily from the 5 th to the 10 th pregnancy [].. Postpartum haemorrhage also more common in grand multipara. Copyright © 2003 - 2020 - UKEssays is a trading name of All Answers Ltd, a company registered in England and Wales. Premature rupture of membranes and prolapse of the cord. https://study.com/academy/lesson/multipara-definition-risks.html Regarding the antepartum haemorrhage, abruptio placentae is more common in GMP. Aims and Objectives At the end of the session, we should be able to: - Diagnose a breech presentation Carry out a breech delivery Be familiar with the manoeuvres if assistance is required Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. CHAPTER 2 Antepartum–Intrapartum Complications Helen M. Hurst OBJECTIVES 1. Ultrasonography was done in non-booked cases when there was suspicious of malpresentation which was defined as presenting part of fetus in other than cephalic in relation to maternal pelvis. Short interpregnancy interval. Perinatal deaths (PND) included all intrauterine death (IUD) and early neonatal deaths (ENNDs). Risk factors for PPH include grand multiparity and multiple gestation. If yes, There is adequate IV access? The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. It is therefore recommended that active management of the third stage of labour be offered to all women during childbirth, whenever a skilled provider is assisting with the delivery (1). Grand multiparity e. Mild pelvic contraction f. Postmature and large infants 5. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. 2. Anemia is more common in grand multipare because of poor nutrition, repeated pregnancies, low socioeconomic status. It is generally accepted that GMP is risk factor of obstetric complication but recently a few reports have appeared in the literature showing that this might be fiction rather than fact. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Admission to NICU. Lacerations of the genital tract. This is not an example of the work produced by our Essay Writing Service. Our study showed no statistical difference in postpartum haemorrhage between both groups. Aziz FA, studied the grand multipare Sudanese women and found the incidence of pre-term labour was increased in these women 18. We observed 8% NICU admissions in high parity group that was not statistically significant (p 0.213) as compared with 3% NICU admissions in low parity group (Figure-4). List maternal risk factors that may exist before pregnancy. What is a high-risk pregnancy? • Grand multiparity. (i.e. You can view samples of our professional work here. SAMPLE SIZE: A total of 200 pregnant women were selected randomly, were divided into two groups with 100 women in each group. ( grand multiparity, poorly managed third stage of labour with a fundally situated placenta). Grand Multiparity , in older literature is defined as parity >7.LSCS was 20% and 11% in control group and The definition of grand multipara has benstudy group. No maternal death was observed in low parity group but one (1%) maternal mortality was observed in high parity group, however difference of maternal mortality rate was insignificant (p = 0.999) between two groups (Figure-2). Low multiparae is woman who has delivered less than five (para 1-4). Nursing Care of the New Mother and Postpartal Complications Molly Brand, MSN, RN Nursing Instructor Nursing Grand multipara: The term "multipara" applies to any woman who has given birth 2 or more times. Grand Multiparity , in older literature is defined as parity >7.LSCS was 20% and 11% in control group and The definition of grand multipara has benstudy group. Retained placenta after vaginal delivery: risk factors and management Nicola C Perlman, Daniela A Carusi Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Daniela A CarusiDepartment of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USATel +1 … Grand multiparity reported to increased both maternal and perinatal morbidity and mortality5,6. Amniotic fluid probably enters the maternal circulation through the endocervical veins, the placental insertion site, or a site of uterine trauma. Although the incidence of grand multiparity is low in economically developed countries, religious or cultural factors mean that it is common in some populations or communities. Despite of availability of modern obstetric facilities, women in our society not intend to get book for antenatal care because they are too busy at their home and lack of awareness about health care, We found in our study that most of the patients in both groups coming in Civil Hospital, Karachi were non-booked and referred from different areas with complications. Very high presenting part Maternal shock Contractions may stop Peritonism Likely to be abnormal FHR with acute fetal compromise Key words: Primary Postpartum hemorrhage (PPH), Uterine atony 1. Pregnancy induced hypertension (PIH) was more common in our study, these women were relatively older than low parity and my study was not age matched study. This is when the mother has given birth 5 or more times. Rapid labor. * Significant difference (X2 = 6.44, d.f = 1, p = 0.011), * Shows statistically significant difference at p < 0.05, * Significant difference (Fisher’s exact test, p = 0.005). As our study was not age matched study. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. The woman may also obtain lacerations of the birth canal due to forceful birth. Problems in the pelvis or soft tissues of the reproductive tract. * Shows significant difference (X2 = 18.6, d.f = 3, p = 0.001), Low parity: Parity 2-4, High parity: Parity > 4, * Significant difference (X2 = 2.13, d.f = 2, p = 0.344). Grand multiparity (GM) was identified from detailed parity data and defined as women with at least five live births. a. Ppt). prolonged labour, multiple pregnancy, big baby, polyhydramnios, grand multiparity, clotting dysfunction, PPH in the past). Commonest age group in both study groups was 20 – 25 years in which total 76 patients were observed, however this age group was significantly higher (46% vs. 30%, p=0.001) in low parity group that high parity group while older age group of the study 36 – 40 years was higher in high parity group than low parity group (4% vs. 15%). Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg & prolonged labour. In third world countries like Pakistan the large families are still common. Discomfort to the patient. Increased lumbar lordosis. Significantly high number of fetal mortalities was observed in high parity group than low parity group (16% vs. 4%, P = 0.999) (Figure-3). However, PPH may occur in women without identifiable clinical or historical risk factors. Abdominal binder. Bleeding disorders. She found no direct association between grand multiparae and PPH.63 Some other studies have shown that increased risk of PPH is associated with increased age not with increasing parity. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Increased age of GMP women put them additional risk for complication. Prolonged labour, uterine overdistension, grand multiparity, retained placental tissue or haematometria (abruption) may contribute to inadequate myometrial contraction. Breech presentation 1. Categorize intrapartum conditions that may result in complications for the newborn infant. The incidence of grand multipara has decreased in most western countries in recent years due to better socioeconomic status and high use of contraception11,12,13. *You can also browse our support articles here >. Previous stillbirth or neonatal death. Contraction of the uterine muscles during labor compresses the blood vessels and slows flow, which helps prevent hemorrhage and facilitates coagulation. Baby weighing <2.5 kg or >4.5 kg. Grand multiparity reported to increased both maternal and perinatal morbidity and mortality5,6. Uterine rupture. Prolonged labour. Heija AA, also found in his study that abruptio placentae is more common in grand multipareae. These data remain comparable throughout the 30-year period until 2018. Uterine atony. The intrapartum complications included prolonged labour and ruptured uterus. Although the patients in here study were booked patients, she reported that higher prevalence of these complications may be explained on the increased age of these women. Uterine atony is the failure of the uterus to contract adequately following delivery. • Reduce the dose of misoprostol to 200 micrograms every 6 hours. 4. Grand multiparity (≥7 deliveries in obstetric history) accounted for 12.4% (59/475) of all uterine ruptures while short inter-pregnancy interval has been observed in 12.0% of all uterine ruptures (57/475) . Study for free with our range of university lectures! 2. Munim noted in her study PPH was three times more common in grand multipara4. Grand multiparous have been considered to be at higher risk of developing antenatal complications. Pregnancy outcome in grand and great grand multiparity. Most often problems with the passageway are a result of pelvic abnormalities that interfere with the engagement, descent, and expulsion of the fetus. Contraction of the uterine muscles during labor compresses the blood vessels and slows flow, which helps prevent hemorrhage and facilitates coagulation. Are there any concerns about the placental site No Yes. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. Munim S, et al., found in her study statistically significance difference in the induced of the PIH that was 15.4% in grand multipare compared to the 9.3% in low parity women 4. Key: Booked = 3 or more antenatal visits. A woman who has given birth 5 or more times is called a grand multipara. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. List maternal risk factors that may exist before pregnancy. MH Al Sibal, MS Rahman, J RahamObstetric problems in the grand multipara: a clinical study of 1330 cases. In high parity group, proportion of women who underwent caesarean section was significantly higher in high parity group than low parity group (16% vs. 5%, p=0.011). Assess the fetus/neonate for effects of tocolytic drugs. Uterine atony is the failure of the uterus to contract adequately following delivery. At the end of pregnancy Singleton pregnancy Amniotic fluid embolism. Preterm labour was same in both groups. Uterine inversion is a rare but dramatic cause of uterine atony and haemorrhage. Clipping is a handy way to collect important slides you want to go back to later. Grand multiparity (GM) was identified from detailed parity data and defined as women with at least five live births. To compare obstetrical complications between grand multiparae and low parity women. Abnormal fetal presentation. Fisher’s exact test was applied to compare maternal and fetal mortality and nursery care admissions between low parity and high parity groups due to typically low expected count (< 5). 2. Data analysis was performed through SPSS version-10.0. Unbooked 13% and 14% referred from different areas. Prolonged labour. There was no significant increased incidence macrosomic babies in grand multiparae, compare with international literature. The intra partum complication like obstructed labour result was same in both groups in both cases patients was referred and reason was abnormal fetal position. Obstet Gynecol, 8 (1987), p. 135. 4. With increasing skills and Are there any concerns about the placental site No Yes. In case of 2 or more previous uterine scars or grand multiparity or overdistention of the uterus: • Preferably use the combined regimen mifepristone + misoprostol, as fewer numbers of misoprostol doses are required. The grand multipara—still an obstetric problem: journal of obstetrics. Obstructed labour and rupture uterus. For expecting mothers, the onset of labor is a highly-anticipated process; however, close to 25% of women will have their labor induced. Oxytocin can cause contractions to be too strong and too frequent, which puts a lot of strain on the uterus . Our study showed caesarean section is significantly increased in grand multipare than the low parity, this because of malpresentation and obstructed labour, antepartum haemorrhage. Grand multiparity | michigan birth injury & hie attorneys. Placenta praevia. 3. If you need assistance with writing your essay, our professional essay writing service is here to help! Week 10 Class 15 Intrapartum Complications with answers(1) (3).ppt - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Free resources to assist you with your university studies! [] Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth. Grand multi parity is a common problem in this part of world and when added to low socioeconomic status, it significantly increases the risk to mother and fetus8,14,15. VAT Registration No: 842417633. – Grand multiparity (5 deliveries or more) – Uterine malformation – Twin pregnancy – Prematurity – Placenta praevia – Foeto-pelvic disproportion. 131 % (Table-2). During labour patients were managed according to units protocol and partogram recording was used to evaluate the progress of labour. Rupture uterus was frequently changed in more recent literatures to delivery order of five or above.4, 5. No Yes . Looks like you’ve clipped this slide to already. So the age distribution was significantly different in two groups (Table-1). Grand multi parity is the condition of giving birth after the 28th weeks of gestation, following 5 or more previous viable babies. 8- prolapsed umblical cord9- macrosomia10- suspected CPD11- prior classic uterine incision12- prior rupture of uterus13- pelvic structural deformities14- inability to adequetely monitor of FHR during labor15- multiple pregnancy 16- grand multiparity ( >= 5 previous pregnancies > 20 w) However, PPH may occur in women without identifiable clinical or historical risk factors. In spite of increased incidence of PIH the superimposed pre-eclampsia and eclampsia was no more common in my study.4. Age, parity, socioeconomic status, detailed obstetrical history, past history were recorded and previous record was received to detect antenatal complication including anaemia, PIH, APH, and malpresentation , pre-term labour. Neonates were followed for neonatal complication which included, LBW, macrosomia, perinatal death. Birth weight of < 2.5 kg was taken as LBW and > 4.2 was taken as macrosomic babies. Discuss the effects of hypertension and diabetes on the maternal–placental–fetal complex.