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Journal articles on the topic 'Elderly Primigravida'

Author: Grafiati

Published: 5 June 2025

Last updated: 25 June 2025

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1

Sabha, Madieha, and Khushbu Bashir. "Fertility, conception and complications in elderly primigravidas a comparative study: observational study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 12, no. 7 (2023): 2119–22. http://dx.doi.org/10.18203/2320-1770.ijrcog20231920.

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Background: Incidence of elderly primigravida has increased now days, due to rising education level, effective means of birth control and high carrier goals. The women who conceived at advanced age (>35 years) for first time is defined as elderly primigravida. Indian standard is fixed at more than 30 years by Dutta 2013. These women are high risk for maternal and foetal complication and outcome. The study was done to assess pregnancy outcome in elderly primigravida. Methods: This was a prospective comparative study done in 180 patients over a period of 18 months from September 2017 to March 2019. Among 180 patients 90 patients were elderly primigravidas more than 30 years of age and 90 patients were young primigravidas aged 20 to 29 years. Results: Majority of elderly women though married early, conceived late, many women required other ovulation induction to ART dueto many associated complication with elderly primigravida C-section rate is higher in elderly as compared to vaginal delivery. Conclusions: Elderly primigravida >30 years old had more difficulty in conceiving spontaneously as the fecundity is less with advanced age. The need for ovulation induction and other artificial reproductive techniques is higher in women with advanced age. The complications during pregnancy, labour and postpartum is higher in elderly primigravidas as compared to women less than 30 years of age.

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Singh, Kritina, Prashant Shrestha, Jeena Baaniya, and Prashansa Gurung. "Pregnancy Outcome Among Primigravidae Aged 35 Years and Above: A Comparative Study." Journal of Lumbini Medical College 8, no. 1 (2020): 17–21. http://dx.doi.org/10.22502/jlmc.v8i1.331.

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Introduction: Maternal age is an important determinant of pregnancy outcome. Women aged 35 years ormore at their first pregnancy are considered high risk as they are associated with increased adverse maternaland perinatal outcomes. Methods: A retrospective, comparative study was carried out over a period of two years in a tertiary center. Each elderly primigravida was matched with two primigravidwomen aged 20-34 years who delivered during the same period. Secondary data on obstetric outcomes (diabetes, oligohydramnios, polyhydramnios, hypothyroidism), postpartum complications (post-partum hemorrhage, postpartum eclampsia) and perinatal outcome (intra-uterine growth restriction, prematurity, congenital anomalies, and neonatal death)of 82 elderly primigravidae (study group) was compared to 164 younger primigravida (control group) delivered during the period of study. The Chi Square test and Fisherâ€™s Exact test were used for statistical analysis and p value of <0.05 was taken as level of significance. Results: During the study period, there were 15,012 deliveries and 82 of these were elderly primigravidae giving an incidence of 0.55%. The mean age of the elderly primigravidae was 36.8Â±2.16 years. The study group had more antepartum complications with preterm labor, diabetes in pregnancy, hypertensive disorders in pregnancy, multiple pregnancy and polyhydramnios (p<0.05). Seventy-one elderly primigravidae were delivered by caesarean section, the commonest indication being maternal request. The study group had higher incidence of post-partum hemorrhage but no perinatal mortality of significant proportion. Conclusion: Maternal age at the first pregnancy influences pregnancy and neonatal outcomes. Hence, elderly primigravidae should be considered as high risk and followed up accordingly.

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Pradhan, Kumudini, Lina Baru, and Ashish Dharua. "Pregnancy outcome in elderly primigravida." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 12 (2019): 4684. http://dx.doi.org/10.18203/2320-1770.ijrcog20195172.

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Background: Incidence of elderly primigravida has increased now days, due to rising education level, effective means of birth control and high carrier goals. The women who conceived in advanced age more than 35 years for first time is defined as elderly primigravida. Indian standard is fixed at more than 30 years by Dutta 2013. These women are high risk for maternal and foetal complication and outcome. The study was done to assess pregnancy outcome in elderly primigravida.Methods: This is a prospective hospital-based study done from October 2016 to November 2018. Women of reproductive age group with first pregnancy admitted to department of obstetrics and gynaecology, Veer Surendra Sai Institute of Medical Science and Research, Burla were taken after exclusion criteria.Results: The incidence of elderly primigravida was 2.51%. But majority (84.76%) though married early, conceived late. Most of them are belongs to high socioeconomic group (62.86%). Anaemia was commonest complication (28.57%), fibroid in 5.71% cases. Pre-eclampsia (18.09%), eclampsia (3.81%), IUGR (12.38%) and twin pregnancies (5.72%) were seen more frequently than young primigravida. 55.24% were developed complications during labour like foetal distress (33.33%), PPH (3.81%) and retained placenta (2.86%). Gestational diabetes mellitus in (0.95%), caesarean section rate 29.52%, normal delivery 51.42%, and congenital anomaly 8.15%.Conclusions: Elderly primigravida are high-risk for several complications like spontaneous abortion, preterm labour, prolonged labour, foetal distress, high caesarean rate, PPH, congenital anomaly and increased incidence of perinatal mortality. Majority of this patients properly supervised are capable of safe and successful pregnancies ending in healthy mother and healthy baby.

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4

Resnik, Robert. "The Elderly Primigravida in 1990." New England Journal of Medicine 322, no. 10 (1990): 693–94. http://dx.doi.org/10.1056/nejm199003083221010.

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5

Narwat, Yogesh, Annet Thatal, and Pesona Grace Luksom. "Fetomaternal outcome in elderly primigravida." Indian Journal of Obstetrics and Gynecology Research 7, no. 2 (2020): 243–46. http://dx.doi.org/10.18231/j.ijogr.2020.050.

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Pegu, Bhabani, and Bhanu Pratap Singh Gaur. "Elderly primigravida and a comparative analysis of their pregnancy outcome with younger primigravida." International Journal of Research in Medical Sciences 6, no. 11 (2018): 3478. http://dx.doi.org/10.18203/2320-6012.ijrms20184402.

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Background: Though pregnancy and child birth is a normal physiological process but a woman with advanced age is a risk factor for adverse pregnancy outcome. This study was conducted to find out the proportion of elderly primigravida and to compare their pregnancy outcome with that in younger primigravida of aged 20-25yrs.Methods: A retrospective study was carried out over a period of two years in a tertiary care hospital of Meghalaya. Secondary data on obstetrics outcome of 54 elderly primigravida aged ≥35 years (study group) was compared to 120 younger primigravida (control group) of aged 20-25 years, delivered during the period of study. The chi square test and Fisher’s exact test were used for statistical analysis and p value of <0.05 was taken as level of significance.Results: During two years of study period, 2048 patients had delivered, out of which 411 (20.1%) were primigravida, 54 (2.6%) were elderly primigravida, 120 (5.9%) were in the younger age groups and 66 (3.2%) were teenage pregnancy. Pregnancy induced hypertension (PIH) with preeclampsia 12 (22.2%), preterm labour 2 (3.7%), instrumental delivery 6 (11.1%), caesarean section 32 (59.3%) were found significantly higher in study group.Conclusions: In our study, the prevalence of elderly primigravida was 2.6% and they had high rates of complications during antenatal period and course of labour than younger primigravida.

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Smitha, K1, B. T. Veena, Varadarajan Reethu, and Sushma. "A Comparative Study of Pregnancy Outcome in Elderly Primigravida and Younger Primigravida." International Journal of Current Pharmaceutical Review and Research 16, no. 01 (2024): 96–101. https://doi.org/10.5281/zenodo.10990816.

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AbstractBackground: Societal changes in maternal age demographics, marked by increased educational andprofessional pursuits, necessitate an in-depth examination of pregnancy outcomes for elderly primigravida.Understanding the complexities surrounding advanced maternal age is crucial for tailoring effective antenatalcare and interventions to ensure favorable maternal and neonatal outcomes.Objective: This study aims to compare pregnancy outcomes between elderly primigravida (≥35 years) andyounger primigravida.Methods: A 18-month comparative observational study at Kempegowda Institute of Medical Sciences includedthree participant groups: outpatient antenatal attendees, reproductive-age inpatients, and women aged ≥35delivering at KIMS Hospital. Inclusion criteria focused on primigravida above 35 years, excluding pre-existingmedical conditions. Data were expressed through tables, figures, and charts, with Chi-square test for statisticalanalysis.Results: Elderly primigravida had a significantly higher mean age (35.96 vs. 24.34). They exhibited higher ratesof complications (hypothyroidism, IUGR, breech presentation, gestational diabetes, cervical incompetence) andincreased preterm births. Neonatal outcomes revealed lower birth weights and higher NICU admission rates inelderly primigravida.Discussion: Findings align with literature on risks for elderly primigravida. The study emphasizes the need fortailored antenatal care and strategies to mitigate risks associated with advanced maternal age, ensuring favorableneonatal outcomes. Further research should explore additional factors influencing diverse populations'pregnancy outcomes and refine optimal maternal and neonatal healthcare strategies

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Shweta Sharma, Shishram Saini, Rizwana Shaheen, Asmita Arun, Neetu Gehlot, and Kirti Gupta. "Study of fetal and maternal outcome and associated risk factors in elderly primigravida pregnant women at tertiary care center in Western Rajasthan." Asian Journal of Medical Sciences 16, no. 5 (2025): 66–70. https://doi.org/10.71152/ajms.v16i5.4451.

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Background: Elderly primigravida is one aged 35 or more at first delivery. Elderly primigravida combines the concerns of advanced maternal age with those of obstetrically untested primigravida. While the risks related to multiple pregnancy and previous pregnancy are not applicable, there is an added dimension of precious pregnancy reflecting concern this pregnancy maybe the one and only opportunity to have a child. Aims and Objectives: The aims and objectives of the study are to determine antenatal complications among elderly primigravida woman and maternal and fetal outcome associated with pregnancy in elderly primigravida women. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology at Umaid Hospital, Jodhpur, on 90 patients during the period of February 2024–July 2024 at Umaid Hospital, Jodhpur, in primigravida females of age 35 or more having their first delivery at Umaid hospital. Patients who gave consent and satisfied inclusion criteria were included in study. Results: Mean age of patient was 36.7 years and mean gestational age of delivery was 37.1 weeks. Major cause of delayed conception was infertility (58.9%) followed by late marriage (40%) and career preference (1.1%). Common antenatal obstetric complications in elderly primigravida were HDOP (28.8%), oligohydramnios (17%), gestational diabetes mellitus (14.4%), and preterm labor (11%). Twin pregnancies were significantly higher in patients aged 40 and above (58.3%) compared to younger patients. Conclusion: The study shown that advanced maternal age pregnancy is a high risk pregnancy which needs special care and more careful antenatal monitoring. Significantly higher incidence of hypertensive diseases in pregnancy and twin gestation was seen with increasing maternal age.

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Mohapatra, Ipsita, Swetalin Mishra, Ajit Kumar Nayak, Madhusmita Hembram, and Rabindra Naik. "Maternal Complications and Foetal Outcomes in Elderly Primigravida." SSR Institute of International Journal of Life Sciences 10, no. 4 (2024): 5809–14. http://dx.doi.org/10.21276/ssr-iijls.2024.10.4.2.

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Bhankhar, Ronak R., Anjali R. Chavda, and Hemali N. Patel. "A study of fetomaternal outcome in elderly primigravida." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 12, no. 3 (2023): 716–20. http://dx.doi.org/10.18203/2320-1770.ijrcog20230544.

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Background: Elderly primigravida is defined as all women going through their first pregnancy over the age of ≥35 years. They are considered to be categorized as high-risk pregnancy. Advanced contraception methods and artificial reproductive technology have played key role in delaying the pregnancy. Methods: A retrospective study of fetomaternal outcome in elderly primigravida was conducted at department of obstetrics and gynecology, GMERS medical college, Junagadh from 1st September 2021 to 1st August 2022. All the patient data was obtained from their case records and indoor files and were followed up till delivery for fetal outcome. Results: There were 54 elderly primigravida patients in our study with an incidence of 1.05% based on the inclusion criteria with 96.3% between the age 35-40 years. Most common reason for delayed child bearing was pursuing higher education and work preferences. Gestational hypertension was most common maternal complication (48%), associated with preeclampsia in 28%. Among fetal complications 46% had low birth weight, 38.5% had IUGR. 54% patients had delivered by LSCS. Conclusions: Although elderly primigravida is considered a high-risk pregnancy with increased maternal and fetal complications, proper antenatal care, early recognition of maternal risk factors with timely intervention pregnancy outcome can be improved.

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Cario, G. M., R. E. Fray, and N. F. Morris. "The obstetric performance of the elderly primigravida." Journal of Obstetrics and Gynaecology 5, no. 4 (1985): 237–40. http://dx.doi.org/10.3109/01443618509067765.

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Urquhart, D. Rennie, and Christina Tai. "Obstetric Performance in the Elderly Malaysian Primigravida." Asia-Oceania Journal of Obstetrics and Gynaecology 17, no. 4 (2010): 321–25. http://dx.doi.org/10.1111/j.1447-0756.1991.tb00281.x.

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13

Ojo, A., and U. Oronsaye. "Who is the elderly primigravida in Nigeria?" International Journal of Gynecology & Obstetrics 26, no. 1 (1988): 51–55. http://dx.doi.org/10.1016/0020-7292(88)90195-6.

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Begum, Arzu Manth Ara, Khodeza Tul Kobra, Nazneen Shova, and Md Shafiqur Rahman. "Obstetric and perinatal outcome of primigravida patients in different age group." Journal of Dhaka National Medical College & Hospital 21, no. 1 (2015): 23–27. https://doi.org/10.3329/jdnmch.v21i1.77824.

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The objective of this study was to evaluate the clinical profiles and outcome of primigravida patients in different age group. Materials and method: This study was comparative study which was conducted in the department of Gynaecology and obstetrics, Dhaka National Medical College Hospital, Dhaka. Study period was taken from July 2009 to December 2009. 100 primigravid pregnant women from 36 weeks to 41 weeks in three different groups were included in this study. Group A (20-29 years) with 63 patients, group B (<20 years) with 11 patients & group C (>29 years) with 26 patients. Results: All patients of three groups delivered within or near two years of marriage. In our study, percentage of caesarean section was quite high that is 46% of group A, 45% group B & 96% of group C women. In most cases of group A, LUCS were done due to foetal distress. In group B, due to CPD & in group C, were due to foetal distress and failed trial. Birth asphyxia was more in group B. IUGR was found in only group C about 4%. No significant difference was observed by distribution of pregnant women according to their perinatal morbidity. Conclusion: This study showed teenage and elderly patients were suffered more from different complications. Elderly primigravid patients need comparatively more operative interferences for delivery of their babies . From this study, we should aware to avoid teenage pregnancy and should give special care for elderly primigravid woman during their pregnancy period and labour to achieve healthy mother and healthy foetus. J. Dhaka National Med. Coll. Hos. 2015; 21 (01): 23-27

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15

Yu, Han Ki. "A Clinical and Statistical Study of the Elderly Primigravida." Ewha Medical Journal 14, no. 4 (1991): 329. http://dx.doi.org/10.12771/emj.1991.14.4.329.

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Mishima, Nobuyuki, Seiji Kanda, Koichiro Tabuchi, et al. "An Imported Case of Falciparum Malaria Infection in Japanese Elderly Primigravida." Journal of Kansai Medical University 63 (2012): 1–6. http://dx.doi.org/10.5361/jkmu.63.1.

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Singh, Kirti, Neema Acharya, Sourya Acharya, and Mohit Agrawal. "Latent Chronic Kidney Disease (CKD) Manifesting as Eclampsia in Elderly Primigravida." Journal of Evolution of Medical and Dental Sciences 9, no. 47 (2020): 3596–97. http://dx.doi.org/10.14260/jemds/2020/790.

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Eke, A., and G. Eleje. "P84 The pregnancy outcome in elderly primigravida: A five year review." International Journal of Gynecology & Obstetrics 107 (October 2009): S435. http://dx.doi.org/10.1016/s0020-7292(09)61575-7.

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Vora, Priyanka H., Rana A. Choudhary, and Kedar N. Ganla. "Sildenafil citrate to improve colour doppler indices in patient with pre-eclampsia: a path less taken." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 12 (2020): 5124. http://dx.doi.org/10.18203/2320-1770.ijrcog20205259.

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Presented a case of high-risk pregnancy of an elderly primigravida who had abnormal colour doppler indices. Addition of sildenafil citrate lead to improvement of colour doppler indices and growth parameters, thus prolonging the period of gestation by 6 weeks. This led to decreased neonatal ICU stay and reduction in neonatal morbidity.

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Undinti, Nagashree, Charumathi R., Rama Narasimhan, and Neetu Mariam Alex. "Severe acute respiratory distress syndrome in COVID-19 infected pregnancy: a case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 1 (2020): 368. http://dx.doi.org/10.18203/2320-1770.ijrcog20205801.

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Corona virus 2019 is an emerging disease with a rapid increase in cases and deaths. Limited data is available about its progress and consequences in pregnancy. We present clinical challenges and potential strategies for optimal materno fetal surveillance by a case report on how we successfully managed a COVID -19 infected elderly primigravida with twin gestation and severe acute respiratory distress syndrome.

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Gehan, AliA, SA Khadiga, GA Amir, and A. Eman. "Efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida." Kasr Al Ainy Medical Journal 21, no. 3 (2015): 109. http://dx.doi.org/10.4103/1687-4625.177813.

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Ghizzoni, Viola, Silvia Gabbrielli, Luca Mannini, et al. "Spontaneous Resolution of an Acquired Uterine Arteriovenous Malformation in an Elderly Primigravida." American Journal of Case Reports 19 (September 27, 2018): 1140–45. http://dx.doi.org/10.12659/ajcr.909635.

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Gupta, Amit, Anju Vij, Tanu Verma, Molly ., Rajender Kumar, and Bharti Gupta. "Myomectomy during cesarean section: is it a contraindication these days?" International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 7 (2020): 3090. http://dx.doi.org/10.18203/2320-1770.ijrcog20202768.

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Myomectomy during the cesarean section is a debatable procedure because of raised risk of associated uncontrollable hemorrhage and postoperative morbidity. 38 years, elderly primigravida, who conceived after primary infertility with large leiomyoma in the lower uterine segment, underwent myomectomy during the cesarean section. Her intra-operative hemorrhage was within normal limits and post-partum period was uneventful. Conclusion of this study is Safety and feasibility of myomectomy along with cesarean largely depends upon the case selection, experience of the obstetrician and backup ICU and transfusion facilities.

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Sultana, M., P. Akhter, AK Saha, and A. Akhter. "Successful Outcome of Pregnancy of a Sub-fertile Woman with Multiple Fibroids and Placenta Praevia and Accreta." Journal of Bangladesh College of Physicians and Surgeons 32, no. 1 (2014): 41–44. http://dx.doi.org/10.3329/jbcps.v32i1.21038.

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Fibroids, the commonest benign pelvic tumor, have a common association with subfertility and increasing maternal age. Placenta praevia and fibroid (if submucous) has an association with placenta accreta. Here we report the case of an elderly primigravida with history of prolong subfertility, admitted with 37 weeks pregnancy with multiple fibroids and central placenta praevia with focal increta. Even with all these complicating factors, with the advent of better uterotonic drugs, conservative management could be considered successfully now-a-days. DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21038 J Bangladesh Coll Phys Surg 2014; 32: 41-44

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Pathan, Zeba H., Niranjan N. Chavan, Shreya Kampoowale, Deepali S. Kapote, and Ashwini S. Sakhalkar. "Caesarean myomectomy in a patient with multiple maternal and fetal comorbidities: a rare interesting case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 11, no. 8 (2022): 2253. http://dx.doi.org/10.18203/2320-1770.ijrcog20221947.

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Caesarean myomectomy has been traditionally discouraged due to the fear of complications like intractable haemorrhage, peripartum hysterectomy, and increased postoperative morbidity. Recently, a number of authors in their studies have shown that myomectomy during caesarean section does not increase the risk of haemorrhage or postoperative morbidity, if adequate haemostatic methods are used and done by skilled surgical hands. Caesarean myomectomy was performed in a case of elderly primigravida with 36-week gestation with chronic hypertension with polyhydramnios with anterior wall pedunculated fibroid of 8.6×7.2×8 cm and multiple small fibroids in the anterior wall, fundus and subserosal plane. Caesarean myomectomy is a safe and effective procedure in a tertiary care centre at hands of an experienced surgeon.

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Sirisha, Vandana Sai, Mahantappa A. Chiniwar, and Sharada B. Menasinkai. "Obstetric outcome in primigravida with unengaged versus engaged fetal head at term." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 1 (2020): 251. http://dx.doi.org/10.18203/2320-1770.ijrcog20205777.

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Background: Labour although a physiological process can present challenges to clinician and patient. Primigravida and nulliparae are obstetric high-risk group, especially the very young and the elderly, where pregnancy and labour must be supervised. The study was done to compare the maternal and fetal outcome in primigravida with unengaged and engaged head at term.Methods: A prospective study was done for a period of 18 months from June 2018 to December 2019 in Department of Obstetrics and Gynaecology Adichunchanagiri Institute of Medical Sciences and Research Center. 100 women with unengaged head at term (group A) and 100 women with engaged head at term (group B) as controls were selected. All the relevant data was filled in the partogram. Following observations were made, station of fetal head at the onset of labour, course of labour, duration of labour, any medical or surgical interventions or caesarean delivery. Data was analysed by SPSS 20.0 software and p value<0.05 was taken as statistically significant.Results: in group A 49% and 63% in group B had vaginal delivery. 17% of group A and 14% of group B had instrumental vaginal delivery. Caesarean delivery was 34% in group A and 23% in group B. The mean total duration of labour was 13.53 hours in group A and 9.73 hours in group B. P value was 0.000.Conclusions: Duration of labour was more in group A than group B. Proper supervision and timely intervention in cases with an unengaged head can have vaginal delivery.

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Basa, Akkamamba, Srujana Palavalasa, and Geetasree Vanapalli. "Study of Fetomaternal Outcome in Elderly Pregnancy in Tertiary Care Center, Kakinada." Journal of Evidence Based Medicine and Healthcare 8, no. 38 (2021): 3360–65. http://dx.doi.org/10.18410/jebmh/2021/610.

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BACKGROUND Advanced maternal age generally signifies age after 35 years at the time of delivery. Maternal age is an important determinant of the outcome of pregnancy. Elderly women are at a high risk of several complications like abortion, ectopic pregnancy, preterm labour, hypertension, gestational diabetes, malpresentation and instrumental deliveries. Older the women, higher the fetal complications like Downs syndrome, preterm baby, low birth weight (LBW) babies and intrauterine growth restriction (IUGR). The purpose of this study was to assess the fetomaternal outcome in elderly pregnancy at a tertiary care centre. METHODS This study was a prospective hospital-based study of 100 elderly pregnant women aged 35 years and above admitted in OBG Department, Government General Hospital, Kakinada, Andhra Pradesh, from June 2020 to May 2021. The labor ward register and case records were used for all elderly gravida women admitted and delivered and details of these patients was recorded in the proforma. RESULTS In this study, 68 % were in 35 - 37 years, 32 % were in 38 - 40 years age group. 36 % were primigravida and 64 % were multigravida. 76 % women were housewives and 24 % women were employed. 32 % of women had history of previous abortions. Hypertensive disorders were observed in 42 % of patients, gestational diabetes was observed in 28 % of patients, antepartum haemorrhage was observed in 24 % of patients, IUGR was noted in 20 % of patients and preterm delivery was noted in 10 % of patients. 46 % of patients were delivered by vaginal route and 40 % of patients were delivered by caesarean section. 7.69 % were intrauterine devices (IUDs), 3.85 % had congenital anomalies. CONCLUSIONS Elderly women are at a high risk of developing several maternal and fetal complications. Many of these complications can be successfully managed with improved health services, pre-conceptional counselling and frequent antenatal visits. KEYWORDS Advanced Maternal Age, Maternal Complication, Caesarean, Preterm Delivery

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Opadiran, R. O., A. D. Isah, N. Adewole, and K. I. Omonua. "Pregnancy outcome in elderly primigravidae at a Nigerian Tertiary Hospital: a five-year review." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 2 (2018): 391. http://dx.doi.org/10.18203/2320-1770.ijrcog20180154.

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Background: Pregnancy though a physiologic process also comes with its complications. This has been found to be related to factors associated with the mother and fetus. Maternal age at first pregnancy is a determining factor which could affect pregnancy outcome. Objective of present study was to determine the effect of maternal age on obstetric outcome.Methods: A five-year retrospective case control study involving primigravid women aged 35years and above (elderly primigravidae) and the younger primigravidae aged below 35 years who delivered at the University of Abuja Teaching hospital (UATH) between 2012 and 2016. Data were collected from their case notes, antenatal and delivery registers. For comparative purposes, obstetric and perinatal parameters including antenatal, labour, delivery, postpartum factors were collected for both the elderly primigravidae and younger primigravidae. A total of 6,052 deliveries, of which 2,456 were primigravidae and 42 of them were ≥35years of age. Out of 42 cases, only 30 folders were found and analyzed. The matched controls were selected consecutively after each elderly primigravidae in the register without prior knowledge of their pregnancy outcome. The data was analyzed using SPSS version 20. Chi square test X2 and student T test were used for comparison of the two groups. Statistical significance was set at P values of ≤ 0.05 at 95% confidence interval.Results: The incidence of elderly primigravidae was found to be 1.2% in this study. There was increased risk of hypertensive disorders in pregnancy, caesarean delivery and low APGAR scores in the elderly primigravidae group but these were not statistically significant. No other differences in obstetrics and neonatal outcome were found between the two groups.Conclusions: Elderly primigravidae are at increased risk of hypertensive disorders in pregnancy and caesarean delivery than in younger primigravidae. On the other hand, neonatal outcome of the two groups were comparable.

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Magistrado, Leila, Mary C. Tolcher, Anju Suhag, Sonal Zambare, and Kjersti M. Aagaard. "Pregnancy and Lactation in a 67-Year-Old Elderly Gravida following Donor Oocyte In Vitro Fertilization." Case Reports in Obstetrics and Gynecology 2020 (September 14, 2020): 1–6. http://dx.doi.org/10.1155/2020/9801565.

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There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum course was uncomplicated, and she was able to successfully breastfeed for six months and resume prepregnancy activity. For comparison, we analyzed deliveries among gravidae>45 years of age from our institutional obstetrical database (2011-2018). This case represents the eldest gravidae identified in the literature and illustrates the potential for a relatively uncomplicated perinatal course with successful lactation. This case may enable other providers to counsel elderly patients on anticipated outcomes inclusive of ability to breastfeed.

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Bassetty, Karthik Chandra, and Reena Dutta Ahmed. "Failed induction of labor (IOL): an overview regarding obstetric outcome and its significance in a health resource poor setting over a period of 11 months." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 8 (2017): 3646. http://dx.doi.org/10.18203/2320-1770.ijrcog20173502.

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Background: The aim of the study was to evaluate the indications and outcomes of failed induction in primigravidae in a tertiary care hospital located in a health resource poor setting.Methods: We conducted a retrospective cross-sectional study on women admitted in the labor room and planned for induction of labor in Assam Medical College and Hospital, Dibrugarh from 1st July 2016 to 31st May 2017. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean section.Results: A total of 201 primigravida patients were selected for the study of which 135 patients delivered by CS and 66 patients by spontaneous vaginal delivery. The average induction-delivery interval was found to be 18.9 hours. Average weight of the babies was 2.9 kg. The following factors are associated with increased rates of failed induction: Bishop’s score less than 5, Gestational age >41 weeks, teenage and elderly primi, oligohydramnios, prelabour rupture of membranes (PROM), hypertensive disorders of pregnancy, induction-delivery interval greater than 24 hours, absence of a dating ultrasound done in 1st trimester, meconium stained liquor, SGA and macrosomia babies. There has been a single maternal death due to rupture of uterus.Conclusions: Most common indication of doing IOL is post-dated pregnancy (>40 weeks of gestation). Majority of women (66%) had no dating ultrasound with them hence they were induced based on last menstrual period which is unreliable in most women leading to failed IOL.IOL protocol i.e. when to repeat and how long to wait was purely the duty consultant’s opinion in our study rather than following a protocol. IOL is an important obstetric procedure hence there is a dire need to develop a protocol for the same in our setup.

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Paratz, E., C. Kao, and J. Somaratne. "Dissection Then C-section: Spontaneous Coronary Artery Dissection, Heart Failure and Left Ventricular Thrombus in An Elderly Primigravida with an IVF Pregnancy." Heart, Lung and Circulation 25 (August 2016): S42. http://dx.doi.org/10.1016/j.hlc.2016.06.093.

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Triza, Kumar Lakshman, S.M Prakruthi, and V. R. Greeshma. "Unraveling Multiple Gestation – Analysis of Risk Factors and Outcome at Tertiary Care Hospital." International Journal of Pharmaceutical and Clinical Research 16, no. 5 (2024): 441–45. https://doi.org/10.5281/zenodo.11402903.

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<strong>Background:</strong> A pregnancy with more than one fetus is called multiple pregnancy. Multiple pregnancies are prevailing due to a dramatic increase in use of ovulation-inducing agents, ART, and  shift towards elderly primigravida and grand multiparity. <strong>Aims and Objectives: </strong>To study maternal risk factors and fetal outcomes associated with multiple gestation. <strong>Materials and Methods:</strong> This retrospective study was carried out at adichunchanagiri institute of medical sciences, Mandya. A sample of 70 mothers with multiple gestation was collected from hospital records regarding maternal age, parity, risk factors, spontaneous or assisted conception, gestational age, pregestational BMI, and family history. Fetomaternal complications that occurred during the antenatal period, labor, and mode of delivery were collected and analyzed. <strong>Results:</strong> Out of 8000 deliveries, there were 70 cases of multiple gestation over 5 years, with an incidence rate of 8.75 in 1000 deliveries. 8.5% are conceived by ovulation induction, 5.7% by IVF. 24% MCDA, 73.28% DCDA, and 2.8% are MCMA twins. Preterm labor (65.6%), anemia (46.8%), and hypertension (10.5%) were common problems. (61.4%) vaginal deliveries and (35.7%) LSCS were conducted. Fetal malpresentation leads to 32% of LSCS. Among fetal complications, FGR was seen in 11.4%.  A low APGAR score was noted in 21.4% of preterm babies. <strong>Conclusion:</strong> Maternal risk factors include multiparity, elderly pregnancy, use of ovulation induction, and ART. Maternal complications are preterm labor, PROM, PPROM, abruption, PPH, etc. Fetal complications noted are  hypoglycemia, respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis, stillbirth, low birth weight etc. Hence the restricted use of ovulation induction ART, promoting early conception. Vigilance during ANC and labor is needed in selecting the mode of delivery. Active fetal surveillance and intervention improve fetomaternal outcomes.    

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Saraogi, Rajendra M., Pramila Yadav, Pabashi Poddar, and Komal Chavan. "Miracle Baby: very Rare Case of Heterotopic Pregnancy with Cervical Ectopic in Elderly Primigravida with very Poor Ovarian Reserve with Oligoastheno-Terato-Zoospermia Conceived with IVF." International Journal of Medical and Dental Sciences 5, no. 1 (2016): 1079. http://dx.doi.org/10.19056/ijmdsjssmes/2016/v5i1/83580.

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A 42 year old with primary infertility over 2 years with poor ovarian reserve (AMH 0.02) with an Oligoastheno-terato-zoospermia had 3 attempts of embryo transfer with her own egg. USG showed a heterotopic pregnancy with fundal 5-6 weeks intrauterine gestational sac with a cervical ectopic with small subchorionic collection along with posterior uterine wall. Despite embryo reduction, it still showed a persistent heterotopic pregnancy with an increasing subchorionic collection in the cervical canal. There was PROM at 27 weeks and under adequate antibiotic and steroid cover, classical caesarean section was done. Due to an adherent cervical pregnancy remnant, bilateral internal iliac artery ligation with an obstetric hysterectomy was done. As few cases exist in literature, there are no specific and no universally accepted treatment modality for heterotopic cervical pregnancy and treatment depends on experience, equipment of medical team and maternal conditions.

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Singh, Vinita, Rajshree Sahu, Esha Das, and Pavan B. C. "A near miss case of placenta percreta in a patient with post myomectomy scar." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 12 (2019): 5062. http://dx.doi.org/10.18203/2320-1770.ijrcog20195373.

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The term placenta accreta or placenta accrete syndrome is used to describe a spectrum of an abnormal placental implantation and firm adherence which are classified according to the depth of invasion into the uterus. A 28-year-old elderly primigravida presented AIIMS OPD to for the 1st time at 13+2 weeks of gestation with brownish discharge per vaginum. Ultrasonography done showed 12 weeks single intrauterine pregnancy with subchorionic haemorrhage of 3.7×2.52 cm with placenta being fundoanterior. She underwent myomectomy 2 years back and during her antenatal care in 3rd trimester growth scan at 30+2 weeks of gestation placenta was fundoanterior with loss of retroplacental hypoechoic in the upper margin of placenta at the myomectomy scar site with small extra uterine collection seen measuring 7.6×2.3 cm and hence possibility of placenta accreta was suggestive by the above findings confirmed by MRI. Emergency cesarean section done at 36+6 weeks of gestation for leaking per vaginum. Manual removal of placenta was tried but it failed and soon atonic PPH developed. Seeing no response with uterotonics internal iliac artery ligation was also attempted but failed. Immediate decision for hysterectomy was taken as a life-saving method. On adhesiolysis in the fundal region placental tissue perforating uterine serosa was visible on the surface of uterus, hence diagnosis of placenta percreta was confirmed which was further confirmed on histopathological report. Currently hysterectomy or local resection is preferred over conservative management with methotrexate.

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Lanre-Ojo Opeyemi Ayodeji, Ayo-Dada Oluwaseun Dorcas, and Adelabu Mobolaji Ayo. "Factors influencing the acceptance of cesarean sections among women of reproductive age in ekiti state, Nigeria." International Journal of Science and Research Archive 12, no. 2 (2024): 828–36. http://dx.doi.org/10.30574/ijsra.2024.12.1.0824.

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The study examined factors influencing the acceptance of cesarean sections among Women of Reproductive age in Ekiti State. Specifically, the study assessed how socio-demographic and socio-economic factors influenced the acceptance of cesarean sections. A descriptive survey research design was employed for the study. The population for this study consisted of women of reproductive age spread across the three senatorial districts of Ekiti State. The sample for the study was 325 women of reproductive age whose selection was based on multistage sampling procedure. An interviewer administered questionnaire was used to collect data for the study. The reliability of the instrument was determined through Cronbach's Alpha method and a reliability co-efficient of 0.9 was obtained. All data obtained were analyzed using descriptive and inferential statistics. The research questions were analyzed with descriptive statistics using frequency counts, percentage, mean and standard deviation. Hypotheses formulated were tested using linear and multiple regression analysis at 0.05 level of significance. The findings revealed that age, educational status, religious belief, cultural belief and socio-economic status respectively has significant influence on acceptance of cesarean sections among the participants. It was therefore recommended that public health officials should re-orientate women of reproductive age on cesarean sections as an alternative means of child delivery; elderly Primigravida and Multigravida women should be encouraged to undergo cesarean sections delivery if there are indications for it in order to reduce the risk of complications through vaginal delivery method.

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Thammaros, Tassana, Kittiphan Chalom, Wanna Hanshaoworakul, Phanthanee Thitichai, Patcharin Tantiworrawit, and Sathirakorn Pongpanich. "Prevalence and Associated Factors of Neonatal Microcephaly in Thailand, 2014-2018." Outbreak, Surveillance, Investigation & Response (OSIR) Journal 12, no. 3 (2019): 100–108. http://dx.doi.org/10.59096/osir.v12i3.262958.

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Microcephaly became of high concern after Zika outbreaks occurred worldwide. An estimation of its prevalence is crucial for public health preparedness and response. The objectives of this study were to estimate the prevalence of neonatal microcephaly in Thailand during 2014-2018, describe its epidemiological characteristics, and identify associated factors. This study was a cross-sectional study using data from the Health Data Center, Ministry of Public Health, Thailand. Neonatal microcephaly, as defined in this study, is a condition where a newborn has a head circumference (HC) less than the 3rd percentile of the International Fetal and Newborn Growth Consortium for the 21st Century standard head circumference charts for term newborn, and Fenton's growth charts for preterm newborn by gestational age and gender. Univariate and multivariate analysis were performed to identify associated factors. During 2014-2018, 121,448 newborns were identified and the prevalence of neonatal microcephaly was 14.5%. There were 9,871 boys and 7,687 girls. Multivariate analysis showed that small for gestational age (adjusted odds ratio (Adjusted OR) 5.34, 95% confidence interval (CI) 3.24, 8.81), birth length less than the 10th percentile (Adjusted OR 2.92, 95% CI 1.36, 6.29), elderly pregnancy (Adjusted OR 1.84, 95% CI 1.07, 3.18), and primigravida (Adjusted OR 2.01, 95% CI 1.37, 2.95) were significantly associated with neonatal microcephaly. The prevalence of neonatal microcephaly in Thailand was higher than expected. The international head circumference chart may not be suitable for Thai newborns suggesting that a head circumference growth standard for Thai newborns is needed.

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Ojule, JD, PO Fiebai, and VC Ibe. "Pregnancy outcome in elderly primigravidae." Annals of African Medicine 10, no. 3 (2011): 204. http://dx.doi.org/10.4103/1596-3519.84699.

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O. ILESANMI O. FAWOLE D. O. OLALEYE, A. "Pregnancy outcome in the elderly primigravidae." Journal of Obstetrics and Gynaecology 18, no. 1 (1998): 40–43. http://dx.doi.org/10.1080/01443619868253.

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Pradhan, Madhusmita, Kishore S. V., and Jyotiranjan Champatiray. "Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy induced hypertension." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 4 (2020): 1590. http://dx.doi.org/10.18203/2320-1770.ijrcog20201229.

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Background: Pre-eclampsia is not totally a preventable disease. It is found more related to chains of social ills such as poor maternal nutrition, limited or no antenatal care and poor reproductive education. However, some specific “high-risk” factors leading to pregnancy induced hypertension (PIH) may be identified in individuals which include and not limited to young and elderly primigravida, multiple pregnancy, diabetes, Rh incompatibility, new paternity, pre-existing vascular or renal disease, family history of hypertension, pre-eclampsia and eclampsia, obesity, thrombophilia. Low dose aspirin given in 2nd trimester in these high-risk women is anticipated to prevent the development of PIH.Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynecology, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13th to 28th weeks were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group having placebo.Results: Protienuric hypertension was high in control group who did not receive aspirin. Low dose aspirin significantly reduces PIH in high-risk group (3.48% in case versus 23.52% in control). Low dose aspirin was not associated with significant increase in placental bleeding. Low dose aspirin was generally safe for the fetus and new born infant with no evidence of an increased likelihood of bleeding.Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.

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Aspiannur, Syaiful, Budi Wicaksono, and Muhammad Hardian Basuki. "Chordoma in pregnancy: case report." Bali Medical Journal 13, no. 2 (2024): 605–9. https://doi.org/10.15562/bmj.v13i2.5211.

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Introduction: Chordoma represents an uncommon form of bone cancer frequently manifesting within the spinal column or cranium. Most often occurs at the top of the spine (basis cranial) or at the bottom of the spine (sacrum). The clinical manifestations of chordoma vary according to the location of the tumor because the lesion grows slowly and can be locally destructive. Typically, chordomas in the spinal column and sacrum manifest with pain and symptoms of nerve compression, including radiculitis, urinary and bowel incontinence, and sexual dysfunctions. Case Report: A 44-year-old woman, elderly primigravida, was referred by a peripheral hospital with suspicion of a mass in the rectum. The patient was then referred to the Surgical Clinic of the Referral Hospital and a Pelvic MRI examination was planned. The patient was then consulted at the maternity clinic at the Tertiary Referral Hospital. Treatment was administered for the preterm rupture of membranes during the 30th/31st week of gestation in the patient. MRI showed a Primary bone tumor destroying Sacral Vertebrae 2,3,4,5 and Part of Sacral Vertebrae 1 with a size of 15.8 x 13.1 x 14.33 cm; Intrauterine Fetus. The patient was planned to be delivered by cesarean section and a core biopsy was performed by an orthopedic colleague. Core Biopsy results showed Chordoma. The patient was planned for surgery by Orthopedics. Conclusion: Chordoma in pregnancy is rare, demanding meticulous management to minimize morbidity. Its obstruction of the birth canal necessitates planned cesarean sections for safe delivery. Pregnant women with Chordoma face challenges like urinary and bowel issues due to pressure from the enlarged uterus. Despite physiological changes during pregnancy, Chordoma exacerbates these problems. An emergency cesarean section was performed in one case due to premature membrane rupture, resulting in an initially unfavorable outcome. However, the baby's condition improved with three weeks of treatment, allowing outpatient care.

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McNeill Love, R. M. C. "The obstetric course of elderly primigravidae—a review." Journal of The Royal Naval Medical Service 78, no. 3 (1992): 159–63. http://dx.doi.org/10.1136/jrnms-78-159.

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AbstractAn increasingly large number of women are now delaying the start of their families until they reach the age of 35 years or older. They are then known as elderly primigravidae in obstetric parlance. This paper reviews recent literature and reports on a retrospective survey conducted by the author of such women at an RAF hospital and presents the findings concerning their ante-natal, intra-partum, post-partum and neonatal outcomes.

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Datta, Kamna, P. Singh, and Namita Chopra. "Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 8 (2019): 3161. http://dx.doi.org/10.18203/2320-1770.ijrcog20193529.

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Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.

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TUCK, SUSAN M., P. L. YUDKIN, and A. C. TURNBULL. "Pregnancy Outcome in Elderly Primigravidae with and without a History of Infertility." Obstetrical & Gynecological Survey 44, no. 1 (1989): 35–36. http://dx.doi.org/10.1097/00006254-198901000-00004.

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TUCK, SUSAN M., P. L. YUDKIN, and A. C. TURNBULL. "Pregnancy outcome in elderly primigravidae with and without a history of infertility." BJOG: An International Journal of Obstetrics and Gynaecology 95, no. 3 (1988): 230–37. http://dx.doi.org/10.1111/j.1471-0528.1988.tb06862.x.

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Seong, Chun hee, Kyung min Park, and Kyoung ja Moon. "Effects of a labour and delivery simulated practice programme for elderly primigravidas." Nursing Open 7, no. 3 (2020): 776–82. http://dx.doi.org/10.1002/nop2.450.

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Gulrandhe, Purva, Priyanka Telang, and Simran Jaiswal. "Optimising Rehabilitation Strategies for Postpartum Elderly Gravida with In Vitro Fertilisation Conception." European Journal of Therapeutics 29, no. 4 (2023): 977–81. http://dx.doi.org/10.58600/eurjther1955.

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Dear Editor, As per World Health Organization (WHO) data, 5-15% of couples of reproductive age experience infertility. In vitro fertilization-embryo transfer (IVF-ET), which initially appeared at the end of the twenty-first century, is not only a core component of assisted reproductive technology but also an important way to treat infertile patients in modern medicine, giving the majority of infertile patients fertility hope [1]. Advanced maternal age (AMA) is a major clinical and social problem. At present, there is a significant increase in the percentage of women who delay pregnancy until their late third or early fourth decade of life [2]. Many elderly women prefer to use IVF to have children. However, it has been observed that the age of the female was one of the key determinants limiting fertility and reproductive results [3]. The International Council of Obstetricians and Gynaecologists introduced the term "elderly primigravida" in 1958 to describe women over the age of 35 who were embarking on their first pregnancy. Pre-eclampsia, gestational diabetes, foetal abnormalities, and premature birth have all been identified to carry an increased risk of maternal and foetal morbidity during the same time [4]. Women of advanced maternal age are frequently considered as if they need the level of care required for any high-risk pregnancy, and they are given special attention even when there is no scientific basis for it and no medical issues are evident. However, because of pre-existing and pregnancy-related morbidity, as well as high maternal expectations, these women require more intervention throughout pregnancy and delivery [5]. Advanced maternal age is linked to several financial, social, and physical problems for the mother as well as for the foetus [2]. Some studies discovered that elderly gravida were more likely to have a child with Down syndrome, as well as a higher chance of miscarriage and hypertension. However, the chances of requiring a Caesarean section, having a preterm or low-birth-weight baby, having a stillbirth, or having multiple births were not as well determined [5,6]. Intense physical change occurs during pregnancy, and many women experience significant emotional upheaval during this time. While improving the chances of favourable maternal and newborn outcomes during pregnancy remains the major objective of prenatal care, emphasis should also be given to how pregnancy-related conditions might influence a woman's life [7]. The loading and position of the vertebral column, as well as the muscular forces along it and in the weight-bearing joints, alter throughout pregnancy. Physiotherapy is vital in obstetrics, both during pregnancy and after delivery [8,9]. Hence, we present this letter to the editor of post-partum elderly gravida with IVF conception with gestational hypertension and gestational diabetes mellitus with cervical stitch in situ with its structured physiotherapy management. Patient Information: A 51-year-old woman and her 57-year-old husband opted for IVF trials because of advancing age, intending to conceive a child. The couple initiated infertility treatment in 2019. The menstrual history was regular, with a 30-day cycle lasting four 4 days, and the flow was of moderate intensity. Hysteroscopy revealed bilateral tubal blockage. IVF trials were carried out, resulting in conception during the third attempt; however, miscarriage occurred during the second month of pregnancy. Additional trials were pursued, leading to the successful conception of the fifth attempt. During pregnancy, the patient developed gestational diabetes and hypertension. As a result, a cervical stitch was placed at the 20th week of gestation. At 33.5 weeks of pregnancy, the patient underwent an elective lower segment caesarean section, giving birth to a baby girl weighing 2.3 kg. Two days after delivery, physiotherapy was recommended. She reported experiencing pain at the suture site, as well as upper and lower backaches, along with urinary incontinence. Clinical Findings: The patient exhibited a well-nourished physique with a mesomorphic body build. Her hemodynamic condition was stable. Upon observation, the patient displayed a forward head posture, thoracic spine extension, anterior tilt of the pelvis, and increased curvature of the lower back. Waddling gait was also observed. Palpation revealed grade 2 tenderness and pain level of 6/10 at the suture site (Pfannenstiel incision) on the NPRS scale. During the general examination, chest expansion was limited, diastasis recti measured 3 cm in width, and pelvic floor strength was assessed as Grade 1. The strength of the upper abdominal muscles was graded as Fair + (6), whereas the strength of the lower abdominal muscles was graded as Fair (5). Therapeutic Intervention: Medical Management – The medical treatment strategy featured a combination of injections and medications to meet particular health concerns. The following drugs were administered to the patient as injections: tax, metro, pan, tramadol, amikacin, augmentin, and lomoh. The patient's treatment regimen included multiple medications in addition to injections. Metformin, Augmentin, Metro, Pan, Chymorol Forte, and Limcee were among these medications. Every medication had a distinct function that helped to manage the patient's medical condition and aid in her recovery. A Jonac Suppository was also used as part of the therapy plan to improve medical management approach. Physiotherapy Management - Patient Counselling The patient was given information about the altered physiological changes that occur in the female body after pregnancy, as well as age-related transitions. The physiotherapist conducted a discussion about the value of regular exercise and how it affects mental and physical health. The patient was given practical advice on nursing practices as well as instructions on splinting measures to alleviate pain at the suture site. In addition, the family received education on postpartum depression, which provided them with the knowledge to assist the patient in making these life-changing changes. Management – Day 1 to Week 1: The patient was given guidance on multiple techniques to help with her rehabilitation throughout. These included teaching the splinting technique, forced expiratory technique, and applying an ice pack to the suture site for 10 minutes three times a day for pain relief. Correct breastfeeding demonstrations were given. Static back and abdominal exercises with 10 repetitions twice a day were included in the patient's exercise program to enhance muscle strength. Additionally, rhomboid stretching (10 repetitions) was used to alleviate the upper back pain. Cervical range of motion exercises (10 repetitions per set) were also performed. The patient was advised to avoid rotational and side flexion movements to prevent strain on the diastasis recti abdominis muscle. Instruction regarding pelvic floor contractions was also provided. Breathing exercises, including thoracic expansion (Figure 1) and deep breathing, were included (10 repetitions for two sets). Ankle-toe movements (20 repetitions twice daily) were introduced to prevent complications and postural correction exercises were initiated. Figure 1. Patient performing thoracic expansion exercise Week 2 – Week 4: Continuing the patient's progression, deeper breathing exercises, including deep breathing and diaphragmatic breathing (10 repetitions for three sets daily) were introduced. Kegel exercises (the hold relaxation technique) were taught for pelvic floor strengthening. Pelvic tilting, hip adductor and abductor rolls, and pelvic bridging (Figure 2) were included, each with a 5-second hold for 10 repetitions once a day. For diastasis recti, transverse abdominis contractions with a 5-second hold for 20 repetitions were incorporated. Bilateral upper- and lower-limb mobility exercises were introduced, accompanied by stretching exercises and strength training. Postural correction exercises remained constant. Figure 2. Patient performing pelvic bridging Week 4 – Week 6: Progression was seen in the Kegel exercises, with the addition of pelvic bridging with hip roll, a combination of hip adductor and abductor rolls, and hook-lying hip rolls, each with a 10-second hold for 10 repetitions. Core strengthening was heightened along with ongoing breathing exercises. Stretching exercises were maintained with a 10-second hold for three repetitions twice daily. Gait and balance training was continued. Week 6 – Week 8: Aerobic exercises commenced, preceded by a 10-minute warm-up and cool-down session. Core strengthening, postural correction, and Kegel exercises were also performed. Quadruped, opposite arm and leg raises, side bends, leg lowers, neck stretches, and cat and camel exercises were introduced. Home Exercise Program: For the patient's home exercise regimen, warm-up and cool-down sessions included low-impact aerobics and modified yoga or pilates. Additionally, running/jogging and resistance training were incorporated for at least 20 minutes, three days per week. Follow-up and Outcomes: The patient underwent assessment for postnatal depression using the Edinburgh Postnatal Depression Scale, and functional activity was graded using the FIM Scale. Pelvic floor grading, mid-stream-stop flow test, and abdominal Manual Muscle Testing (MMT) were used to evaluate pelvic floor and abdominal muscle strength, respectively. The Numeric Pain Rating Scale (NPRS) was used to gauge overall pain levels. A manual technique was applied to grade the diastasis recti. In summary, there was a noticeable moderate improvement following treatment. The patient was advised to return to the rehabilitation clinic over a follow-up period of three weeks. However, since the patient had relocated to another city, a home exercise program was prescribed. A detailed breakdown of the scores for each outcome before and after the treatment is shown in Table 1. Discussion: Physical activity during and after pregnancy is an important aspect as many physical and emotion changes taken place in women body, Ana Victoria Montoya Arizabaleta et al. conducted a randomized trial on 64 pregnant women to study the effects of a 3-month supervised exercise program and came to the conclusion that primarily aerobic exercise during pregnancy enhances health-related quality of life [7]. After a caesarian section, twenty women participated in a pilot study by Qurat Ul Ain et al. to evaluate the pain relief and functional activities following the procedure. The results of the study showed that postnatal exercises increase mobility and alleviate pain in post-natal period [10]. Diastasis recti abdominis (DRA) is more common in pregnant and postpartum women. However, there is a paucity of knowledge about this condition among women. Menaka Radhakrishnan and Karthik Ramamurthy concluded in a scoping review on efficacy and challenges in the treatment of diastasis recti abdominis that recently minimally invasive surgery has been created to reduce IRD. However, it is not always applicable. Exercise treatment is recommended for women, even during pregnancy. Various research on exercise treatment for DRA patients have indicated considerable outcomes, even though the exercise program for DRA has to be thoroughly standardized [11]. According to Kaj Wedenberg et al. prospective 's randomized study on 60 pregnant women, which compared acupuncture with physiotherapy for the treatment of low-back and pelvic pain, acupuncture provided better pain relief and reduced disability as compared to physiotherapy [12]. Using an only one exercise and advice-based physical therapy intervention in early pregnancy, Moffatt, M. et al. conducted a pilot study on the prevention of pregnancy-related lumbo-pelvic pain and noted that several protocol modifications would be necessary to ensure the satisfactory conclusion of a larger-scale study [13]. Conclusion: This presentation posed a challenge because the patient was an elderly gravida. The therapy was customized to accommodate both pregnancy-related adjustments and geriatric changes along with their accompanying complications. The results after treatment indicated a moderate improvement in the outcome measures. This letter has the potential to assist other therapists in devising more effective rehabilitation plans. Sincerely yours

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Naima S Hoque, Kamrun Nahar, Nasreen Akhtar, and Tanzina Islam. "Pregnancy outcome in a bipartite placenta with battledoor cord insertion: A case report:." Z H Sikder Women’s Medical College Journal 6, Number 1 (2024): 44–46. http://dx.doi.org/10.47648/zhswmcj.2024.v0601.09.

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Bipartite placenta is a placenta with two roughly equal-sized lobed separated by a membrane. The umbilical cord mayinsert in either lobe, in velamentous fashion or in between the lobe. The pathogenesis of bipartite placenta is unclearbut advanced maternal age, history of infertility may include the risk factors. Here we presented a case of a primigravid patient who successfully delivered a healthy baby having a “bipartite placenta with battledoor cord insertion”without having any obstetrical complication. She was neither elderly primi nor suffered from subfertility.

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Noor, Nasreen, Najmul Islam, Shagufta Moin, Abbas Ali Mahdi, Sapna Jaiswal та Farzana Bano. "Normal delivery induced stress alters glutathione peroxidase and TNF-α in elderly primigravidas mononuclear cells". Indian Journal of Clinical Biochemistry 23, № 3 (2008): 227–32. http://dx.doi.org/10.1007/s12291-008-0051-1.

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Shrestha, Uma. "Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report." Journal of Institute of Medicine Nepal 41, no. 2 (2019): 67–69. http://dx.doi.org/10.59779/jiomnepal.1050.

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Introduction: Parity more than five is grand multiparity and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and perinatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among young primigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grand multiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome.

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姜, 宇. "A Study of Humanized Care and Satisfaction Improvement Strategies in the Care of Elderly Primigravid Women." Nursing Science 14, no. 02 (2025): 204–8. https://doi.org/10.12677/ns.2025.142027.

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