Elderly Primigravida – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Elderly Primigravida
Women having their first pregnancy at or above the age of 30 years (According to FIGO- 35 years) are called elderly- primigravida.
Complications of elderly primigravida:
1. Complications of mother:
During pregnancy:
➤Abortion
➤ Abruptio placenta
➤ Pre-eclapmpsia
➤ Uterine fibroid
➤ Tendency of post maturity
➤ Medical conditions related to advancing age like – hypertension, DM.
➤Intra-uterine growth retardation.
During labour..
➤Premature labour
➤ Prolonged labour due to uterine inertia,
➤ Impaired joint mobility.
➤Inelasticity of soft tissues of the birth canal.
➤ Maternal and fetal distress
➤ Increase chance of operative intervention.
➤ Retained placenta.
During puerperium
➤Increased morbidity due to operative interference
➤ Failing lactations
2. Fetal complications:
➤ Preterm birth and prematurity.
➤ Intrauterine growth retardation
➤ Fetal congenital malformation.
Management of elderly primigravida
A. During pregnancy/antenatal period:
➤ Frequent antenatal visits throughout the pregnancy is mandatory.
➤ nursing assessment:
✔ Physical status.
✔ The women’s understanding of pregnancy.
✔Family support.
✔Knowledge of infant care.
✔Women husband attitudes toward the pregnancy.
➤ Early diagnosis and treatment of anaemia, PET, malpresentation.
➤ Early detection of abnormalities and pre-decision about route of delivery
B. During labour:
➤ The patient should be delivered in hospital in case of both normal vaginal delivery and caesarian section.
➤ Delivery must be in well-equippedhospital:
✓ If any complication e.g Toxaemia, malpresentation, Eclampsia-C/S. Eclampsia-C/✓ If no complication.
✓ If cervix is not dialated or fetal/maternal distress.nl/
➤ If fails to start spontaneous labour-induction of labour.
➤ if premature labour:
✓ rest
✓ sedation
➤ If membrane ruptured-foot end raised and antibiotic prophylactically.
C. During-puerperium:
➤ As usual and breast feeding.
D. Method of delivery:
➤ Normal vaginal delivery is encouraged if there is no contraindication for both mother
and fetus
➤ Caesarian section is an alternative to vaginal delivery,
➤ Any other complications should be viewed with concern.
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