SPECIAL PREGNANCY CASES The following sections will help you with understanding and coping with special pregnancy cases such as obesity, ectopic pregnancy, malpresentation, multiple gestation, grand multipara and others.

Advanced Maternal Age Pregnancy

Advanced maternal age is defined by pregnancy beyond the age of 35.

A normal woman’s fertility is at its maximum at the age of 23 which slowly declines, so that by the age of 40 years the chances of spontaneous conception are greatly reduced.

Having once conceived, the elderly primigravida has a greater chance to abort even a Normal pregnancy -30% more chances than normal.

The chances of Down’s syndrome are also increased.

There has been an increase in the incidence of this group of mothers because of longer life expectancy, better contraceptive techniques, assisted fertility methods and many more.

The women who conceives towards the end of her reproductive age presents problems of natural aging process like hypertension, diabetes, cardiovascular , renal diseases and other chronic medical conditions.

Fetal factors like abnormal presentations, chromosome anomalies, congenital defects and prematurity etc are more prevalent in these groups.

Also increased rates of cesarean births, maternal and perinatal mortality have been observed.

‘A woman is obstetrically old before she is chronologically old’

Pregnancy in a woman of advanced age is traditionally considered to be ‘high risk’.

Advanced Maternal Age Pregnancy characteristics

Reduced fecundability

The age related decline in fertility appears to be attributable to oocyte depletion. Also the chances of spontaneous abortion and chromosomal anomalies are also higher with advanced maternal age.

Pregnancy induced hypertension

Leiomyoma

Gestational diabetes

A woman who is 40 yeas older when she gives birth to her first child is almost 4 times as likely to develop gestational diabetes as a woman in her twenties.

Preterm labor

The chances of preterm labor are more in these patients not because of the mother but maybe because of increased medical disorders in this group of patients.

Premature rupture of membranes

Multiple pregnancies

Women over the age of 45 are 10 times as likely to become pregnant with multiples as women in their twenties.

Intrauterine growth retardation

This can be not only because of the increased age but also because of PIH and other medical disorders in mother

Third trimester bleeding

Bleeding at this time could be due to placenta praevia, abruption placentas or uterine bleeding of any cause. Because of increases incidence of PIH and hypertension, the risk of abruption placentas is higher in them. With age the risk factor also increases because of changes in the blood flow and the vessels.

Chronic medical conditions

Older women have increased frequency and severity of medical conditioned which again is a high risk factor for them.

Labor complications

Labor complications are also higher in them because of increased incidences if -

• Mal presentations
• Onset of labor – only 50 5 of these go into spontaneous labor leading to induction and associated labor problems

Mode of delivery

Pregnancy in a woman more than 35 years is regarded as premium pregnancy because of all the emotional. Medical and physical reasons. This may lead to increased incidences of cesarean sections in them.
Post partum hemorrhage

The rates of PPH may increase in them due o instrumental delivery or operative delivery. Also the chances of abruption and atonic uterus due to increase in hypertension, placenta pravia, and associated leiomyomas of the uterus.

Fetal distress

Fetal distress was reported to be higher in these patients. These patients also have increased incidence of small for gestational age babies, babies with congenital anomalies and intrauterine growth retardation is also seen more in elderly mothers.