A GRAND MULTIPARA

Relates to a pregnant mother who has got previous four or more viable births. The incidence has been gradually declining over the couple of decades due to acceptance of small family norm but it still constitutes to about one-tenth of the hospital population and accounts for one-third of the maternal deaths in the developing countries.

COMPLICATIONS: PREGNANCY - THERE IS INCREASED INCIDENCE OF:

1) Abortion - spontaneous and Induced

2) Inherent obstetric hazards such as:

• Malpresentation due to pendulous abdomen and increased pelvic inclination resulting from associated lordosis
• Multiple pregnancy and
• Placenta Previa

3) Medical Disorders such as anemia (both iron deficiency and megaloblastic), hypertension with or without superimposed preeclampsia, cardiac disability, exaggerated manifestations of hemorrhoids and varicose veins, hiatus hernia, etc. and

4) Prematurity.

Labor: There is increased incidence of:

1) Cord prolapse due to malpresentation and high floating head at the onset of labor

2) Cephalopelvic disproportion due to-

1. a) Increasing size of the fetus
2. b) Secondary contracted pelvis which is mostly related to ill-nourished mothers and
3. c) Forward projection of the sacrum due to subluxation of the sacroiliac joints, thereby diminishing the inlet conjugate

3) Obstructed labor due to malpresentation, malposition and CPD

4) Rupture uterus, if the obstruction remains undetected and left uncared for

5) Postpartum hemorrhage due to atonic uterus or increased association of adherent placenta

6) Shock due to severe anemia, hemorrhage or unrecognized uterine rupture and

7) Operative interference because of the complications.

PUERPERIUM

1) Increased morbidity due to sepsis, Intranasal hazards

2) Sub involution

3) Failing lactation.

MANAGEMENT: The cases are considered as “high risk”. As such they require adequate antenatal care and should have a mandatory hospital delivery.

DURING LABOR, THE FOLLOWING GUIDELINES ARE PRESCRIBED

1) Pelvic assessment should be done as a routine

2) Presentation and position are to be checked

3) Undue delay in progress should be viewed with concern

4) To take prophylactic measures against PPH.

HOMOEOPATHIC MEDICINES FOR MANAGING DIFFICULTIES DURING PREGNANCY: -

1) Arnica: - often Indicated for relief of soreness that comes from physical exertion and muscle strain. It is also useful for soreness after labour and delivery, and for hemorrhoids.

2) Calcarea phos: - this remedy can help to strengthen a woman who tends toward easy tiredness, poor digestion, cold hands and feet, and poor absorption of nutrients. Some women who need this remedy find only junk food appealing during pregnancy, or have cravings for smoked and salty food.

3) Caulophyllum :- this remedy may be helpful in women with weak muscle tone in the uterus. A history of irregular periods, slow and difficult labour with previous deliveries, or weakness of the cervix may bring this remedy to mind.

4) Carbo Veg: - this remedy can be helpful to a woman who feels weak and faint during pregnancy, with poor circulation, a general feeling of coldness, and a craving for fresh or moving air. A woman who is deeply tired from overwork, many pregnancies close together, or a previous illness may regain some strength with carbo veg.

5) Actaea racemosa: - this remedy can be helpful for women who are nervous, talkative with a tendency to feel fearful and gloomy during pregnancy. They may become over agitated and have fear of miscarriage. Pains shoot from Hip to hip and down the thighs.