Postpartum haemorrhage also more common in grand multipara. 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) . Most of the patients in my study were unbooked, i.e. 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. Passageway abnormalities 1. In our study perinatal mortality was significantly increased in grand multi parity it mainly because of abruptio placenta, PIH, obstructed labour and preterm birth. *You can also browse our support articles here >. Malpresentations and nonegagement. 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. 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). Our study showed caesarean section is significantly increased in grand multipare than the low parity, this because of malpresentation and obstructed labour, antepartum haemorrhage. Prolonged labour. Very high presenting part Maternal shock Contractions may stop Peritonism Likely to be abnormal FHR with acute fetal compromise MCPS, FCPS Assitant Professor of Obstetrics & Gynecology Previous stillbirth or neonatal death. So the age distribution was significantly different in two groups (Table-1). Grand multiparity (>6 children). Sample selection was done according to the following inclusion and exclusion. Discomfort to the patient. CHAPTER 2 Antepartum–Intrapartum Complications Helen M. Hurst OBJECTIVES 1. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. Placentae previa, preterm labour and twin pregnancy were insignificant between two groups (Table-3). 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. Baby with a structural or chromosomal anomaly. Aziz FA, studied the grand multipare Sudanese women and found the incidence of pre-term labour was increased in these women 18. In our study the grand multipara were older then low parity women. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. 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. Ppt). ( grand multiparity, poorly managed third stage of labour with a fundally situated placenta). Many investigators have reported association of LBW with grand multiparae. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. Grand multiparity Pregnancy Maternal outcome Grand multiparity is defined by the International Federation of Gynecology and Obstetrics (FIGO) as 5 deliveries or more [1]. Nursing Care of the New Mother and Postpartal Complications Molly Brand, MSN, RN Nursing Instructor Nursing Complications. During labour patients were managed according to units protocol and partogram recording was used to evaluate the progress of labour. These complications include gestational diabetes, hypertension, anemia, placental abruption, placenta previa, preterm labour, mal-presentation, mal-position, fetopelvic disproportion and intra-partum complication, uterine intertia, dysfunctional labour, uterine rupture, intrauterine death, marosomia and subsequent operative delivery with its consequent risk of maternal mortality and morbidity2,3. 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). 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. Placenta praevia. (i.e. Problems in the pelvis or soft tissues of the reproductive tract. Baby weighing <2.5 kg or >4.5 kg. Now customize the name of a clipboard to store your clips. Copyright © 2003 - 2020 - UKEssays is a trading name of All Answers Ltd, a company registered in England and Wales. – Grand multiparity (5 deliveries or more) – Uterine malformation – Twin pregnancy – Prematurity – Placenta praevia – Foeto-pelvic disproportion. Unbooked 13% and 14% referred from different areas. The woman may also obtain lacerations of the birth canal due to forceful birth. 2. Significantly high number of fetal mortalities was observed in high parity group than low parity group (16% vs. 4%, P = 0.999) (Figure-3). 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. prolonged labour, multiple pregnancy, big baby, polyhydramnios, grand multiparity, clotting dysfunction, PPH in the past). 30/09/2004 Decrease maternal mortality 13 RISK FACTORS OF PPH GENITAL-TRAUMA Recommended articles Citing articles (0) References. Prolonged labour, uterine overdistension, grand multiparity, retained placental tissue or haematometria (abruption) may contribute to inadequate myometrial contraction. Grand multi parity is the condition of giving birth after the 28th weeks of gestation, following 5 or more previous viable babies. This topic will discuss issues related to grand multiparity. Rapid labor. Obstetrical complication are more in grand multiparae than the low parity women. For expecting mothers, the onset of labor is a highly-anticipated process; however, close to 25% of women will have their labor induced. Obstet Gynecol, 8 (1987), p. 135. 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 [].. [] Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth. List maternal risk factors that may exist before pregnancy. Statistical significance was taken at p < 0.05. If this stops the contractions, tocolytic therapy is not needed. Premature rupture of membranes and prolapse of the cord. 131 % (Table-2). The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Chi-square test was applied to compare age, booking status, mode of delivery, pregnancy related complications, intrapartum and postpartum complications and birth weight between low parity and high parity groups. Oxytocin can cause contractions to be too strong and too frequent, which puts a lot of strain on the uterus . Precipitate and preterm delivery although higher age is more significant [6, 7]. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Recommended articles Citing articles (0) References. 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. No Yes . • Uncontrolled use of Pitocin ( Oxytocin). Grand multiparity (delivery of ≥ 5 viable fetuses) Uterine abnormalities. 2. Uterine inversion. 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. Obstet Gynecol, 8 (1987), p. 135. On admission patients history was taken in detail. Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size. These data remain comparable throughout the 30-year period until 2018. Uterine atony is more common in grand multipara, young women and in home delivery. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. Management of PPH requires prompt and efficient multidisciplinary intervention to improve uterine tone; provide adequate fluid and hemodynamic resuscita… a. 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. Looks like you’ve clipped this slide to already. 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. The risk to the mother and child is relatively high in first pregnancy and then this risk decline during second, third and then slowly rises with increasing parity by the sixth pregnancy risks exceeds these of 1st and after that rises steeply with each pregnancy1. (i.e. Pregnancy outcome in grand and great grand multiparity. Urinary incontinence is an underdiagnosed and underreported problem that increases with age—affecting 50-84% of the elderly in long-term care facilities —and at any age is more than 2 times more common in females than in males. a. SAMPLE SIZE: A total of 200 pregnant women were selected randomly, were divided into two groups with 100 women in each group. Short interpregnancy interval. Grand multiparity (>6 children). Do you have a 2:1 degree or higher? To study the frequency of maternal and perinatal mortality associated with complications of grand multi parity. In spite of increased incidence of PIH the superimposed pre-eclampsia and eclampsia was no more common in my study.4. In fact, the rate of induction of labor doubled between 1990 and 2006 and has continued to trend upwards. [] Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth. Grand multiparity e. Mild pelvic contraction f. Postmature and large infants 5. 7.6.3 Management. Page L in her series of study has reported that same result. 11th May 2017 Anemia was taken as haemoglobin of 11 g/dl, PIH was defined as blood pressure of > 140/90 millimeter mercury after 20 weeks of gestation with or without protenuria on two or more occasion 6 hours apart. The malpresentation was more common in grand multipare especially breech was more common than the low parity. Munim noted in her study PPH was three times more common in grand multipara4. Malpresentations and nonegagement. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Were older then low parity as compare to grand multiparity | michigan birth injury & hie.. Grand multiparity ( delivery of ≥ 5 viable fetuses ) Relaxant anesthetics previa, preterm labour was defined labour. Clotting dysfunction, PPH may occur from the rapid release of pressure on the head end of pregnancy Singleton risk... 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