Question

Marni is 31 years old and 35 weeks pregnant. She was initially seen in the emergency room of the hospital in her community and was referred to a tertiary care center in the city after being assessed by the family doctor, who was concerned about preterm labor because of clear changes in her cervix. Marni arrives at the tertiary center escorted by a nurse who reports that she was comfortable and had no contractions during the transfer. She reports that Marni has had no fever, urinary symptoms, nausea, or vomiting and that her bowel movements have been normal.

Dr Green, the on-call obstetrician, proceeds with a medical history. Marni is a grand multipara, gravida 5, para 5, delivering at 37 to 38 weeks. She has not had any terminations, miscarriages, or stillbirths and has had 5 live births, all vaginal with short, uncomplicated labors and uneventful deliveries. She had gestational diabetes in her last 2 pregnancies and her antenatal visits for this pregnancy were unremarkable apart from the diabetes, which is being well-controlled with insulin.

Discuss the complications based on Mani profile and medical history.

Answer 1

Grand multiparity has been associated with increased risks of adverse pregnancy outcomes such as post-partum hemorrhage,gestational hypertension, gestationaldiabetes mellitus and high perinatal mortality. There is also increased prevalence of malpresentation, meconium stained liquor, placenta previa and a low Apgar score.

The cervix may become incompatible as it will not be able to maintain closure and preterm birth occurs.

Insulin resistance of worsen during 32-36 weeks of gestation. So gestational diabetes worsen during this time.

Complications such as excessive birth weight , still birth, preterm birth , serious breathing difficulties can occur.