MAJOR OBSTETRICAL COMPLICATIONS IN AN ELDERLY PRIMIPAROUS WITH A MULTITUDE OF PRE-EXISTING PATHOLOGIES

Abstract

The number of primiparous pregnant women, over the age of 35, has increased considerably in the past few years, because of the elevated level of education and also because the multitude of contraceptive methods. Such a patient suits the category of elderly primiparous and it represents a real obstetrical challenge, due to the numerous complications related to pregnancy and the immediate postpartum, as well as those related to the neonatal prognosis. We present a 35 old years patient, second gestation, primiparous, a partially monitored pregnancy, known with essential hypertension grade III ESC / ESA, insufficiently controlled therapeutically, with target organ damage (exudative retinal detachment, hypertensive choroidopathy), morbid obesity and also with the suspicion of a renal tumor. The rate of complications occurring in the case of an elderly primiparous was increased in the present case. Obstetrical complications occurred: preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, placental abnormalities (placenta accreta), intrauterine growth restriction, chronic fetal distress and finally fetal death in utero. The evolution of the patient in postpartum was burdened by the decompensation of the pre-existing pathology. In conclusion, elderly primiparous is susceptible to obstetrical complications during pregnancy and childbirth, such as premature birth, fetal acute distress, which may result in fetal death, placental abruption, placental abnormalities, preeclampsia, eclampsia, therefore following up the pregnancy requires increased attention and is also a real challenge for the obstetrician.