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High Parity Pregnancy (The Grande Multipara)

High Parity Pregnancy (The Grande Multipara). Max Brinsmead PhD FRANZCOG May 2011. The Effect of Parity on Maternal Mortality. Reasons for Rising Mortality Risk with Increasing Parity. “Wear and Tear” from prior pregnancies Increasing Maternal Age Associated socio-economic factors.

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High Parity Pregnancy (The Grande Multipara)

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  1. High Parity Pregnancy(The Grande Multipara) Max Brinsmead PhD FRANZCOG May 2011

  2. The Effect of Parity on Maternal Mortality

  3. Reasons for Rising Mortality Risk with Increasing Parity • “Wear and Tear” from prior pregnancies • Increasing Maternal Age • Associated socio-economic factors

  4. Pregnancy Wear and Tear • Nutrient depletion • Iron drain from pregnancy and lactation • Calcium and others • Uterine Damage • Myometrial thinning and fibrosis → • Dysfunctional labour • Both hypertonic and hypotonic uterine activity • Unpredictable response to oxytocic agents • Risk of uterine rupture • Endometrial thinning and morbid adherence of the placenta → Placenta previa and also • Retained placenta and PPH

  5. Pregnancy Wear and Tear (2) • Abdominal Wall, Genital Tract and Pelvic Floor • Spherical uterus → unstable lie and malpresentation • Precipitate deliveries and genital tract injury • Uterovaginal prolapse and urinary incontinence • Other Sites • Problems with pelvic stability • Back problems • Varicose veins and Haemorrhoids • Metabolic • Increasing birthweight due to a variety of causes • Sometimes increasing maternal weight

  6. The Effects of Increasing Maternal Age • Increased risk miscarriage and aneuploidy • Increasing age of eggs • Risk of miscarriage is 1:10 at 20 but 1:3 at 40 • Increased rates of multiple pregnancy • An effect of increasing FSH which ripens >1 follicle • Many Diseases • Diabetes • Hypertension • Coronary artery disease

  7. Associated Socio-Economic Factors • Poverty • Illiteracy • Smoking, alcohol & drug abuse • Poor Access to Health Care • War and Famine • Domestic abuse etc.

  8. Common Problems of High Parity • Unstable lie and malpresentation • Dysfunctional Labour • Precipitate delivery • Uterine atony • Obstetric Haemorrhage • Placenta previa • PPH • Uterine Rupture

  9. Management of the Grande Multipara • Take a careful history – past obstetric history • Optimise HB and iron stores • Increased surveillance and screening in pregnancy • Check carefully presentation at each visit >36 weeks • “Watch and wait” in labour • Use oxytocics with caution • Active management of the 3rd stage of labour • Prevention of High Parity • Family Planning • Starts with the first pregnancy!

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