“At Risk” Pregnancies
·
Adolescent Pregnancy (usually
considered < 16):
o Usually no problems with size of pelvis
o Psychological and social problems: stability of relationship, financial
(no DPB until 16), may conceal pregnancy or have poor access to care, if very
young may involve incest ® criminal offence, need support after birth
o Obstetric problems:
§ Inaccurate dates
§ Compliance issues
§ Pre-diagnosis exposure to alcohol/drugs
§ Smoking
§ Risk for
pre-eclampsia (more likely to have less immunological tolerance to partner)
· Elderly Primagravid (> 35):
o Risk of
chromosomal abnormality, twins, pre-eclampsia (more likely to have essential
hypertension, SLE or renal disease), DVT, thyroid disease, gestational
diabetes, labour problems
o IVF pregnancy ® risk of prematurity, IUGR
o Risk of fibroids (which double in size in pregnancy) ® malpresentation, outgrow blood supply (® pain) but usually little problem to pregnancy
·
Grand Multip (>= 5
pregnancies)
o Fe deficiency
o Precipitate labour: can ® uterine rupture due to efficiency
o Post-partum: relaxes quickly ® APH
o Lie can be very unstable
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