The Pregnant Adolescent and Pregnancy Over 40 Years Old

THE PREGNANT ADOLESCENT
AND PREGNANCY OVER 40

YEARS OLD
The Pregnant Adolescent
Reasons why adolescent pregnancy occur:
1 Limited or Lack or appropriate sex education in public schools.
2 Lack of knowledge about (or failure to use ) contraceptives or abstinence.
3 Lack of access to contraceptives based on state laws or insurance coverage.
4 Parental limitation of adolescent’s access to contraceptives.
5 Desire by adolescents to have a baby.

Developmental Task
Adolescence is a vulnerable time for pregnancy because the

developmental task of pregnancy are superimposed on those of
adolescence
The developmental task of the average adolescent are fourfold:

To establish a sense of self-worth or a value system
To emancipate from parents
To adjust to a new bod image
To choose vocation
PRENATAL ASSESSMENT
Adolescent are considered high-risk patients because they have

a high incidence of iron-deficiency anemia and premature labor.
Adolescent also have a higher incidence of low-birth-weigth

infants, an increase in cesarean birth rates, and a high rate of
intimate partner violence.
PRENATAL ASSESSMENT
FACTORS CONTRIBUTING TO THE LACK OF PRENATAL CARE:

Denial of pregnancy
Lack of knowledge of the importance of prenatal care
Dependence on others for transportation
Feeling awkward in a prenatal setting (an adult setting)
Fear of a first pelvic examination
Difficulty relating to authority figures
COMPONENTS OF PRENATAL
ASSESSMENT
HEALTH HISTORY
Take a detailed health history of an adolescent at the first prenatal visit to establish
individual risks. This is best done without a parent present.
When interviewing adolescents, be certain to press for the responses needed to allow
you to assess them safely. Ask for details.
If an adolescent delayed seeking health care, ask for the reason for this at her first
prenatal visit.
If a parent accompanies a girl, ask the parent separately what, if any, concerns he or she
wishes to discuss.
Family Profile
Day History
ASSESSMENT
PHYSICAL EXAMINATION
PREGNANCY EDUCATION
Nutrition
Activity and Rest
Physiologic Changes
Childbirth Preparation
Birth Decisions
Plans for the baby

COMPLICATIONS OF
PREGNANCY
Iron-Deficiency Anemia
Deficiency is revealed
by chronic fatigue,
pale mucous
membranes, and a
hemoglobin level
less than 11 g/dl.
COMPLICATIONS OF
PREGNANCY
Iron-Deficiency Anemia
Associated with pica, or the ingestion of inedible substances such as
blackboard chalk.
All pregnant women should take an iron and folic acid supplement,
but these are especially important for the adolescent.
Preterm Labor
COMPLICATIONS OF LABOR,
BIRTH, AND THE POSTPARTUM PERIOD
Cephalopelvic Disproportion
Postpartum Hemorrhage
Inability to Adapt Postpartally
Lack of Knowledge About Infant Care.

THE PREGNANT PATIENT
OVER AGE 40 YEARS
THE PREGNANT PATIENT OVER
AGE 40 YEARS
The incidence of individuals delaying their first pregnancies until their late 30s or
early 40s is increasing so much that 15% of births in the United States today are
to those aged 35 to 39 years and 3% are to those over 40 years.
Advanced maternal age is the label for pregnant patients 35 years and older at
delivery. In the past, it was assumed a patient over 40 years was past the optimal
age for childbearing and so was at risk for many complications.
There is little evidence of serious complications in those older than 40 year as long
as prenatal care is begun early in the pregnancy.
Developmental Task
The developmental challenge of the over-40-year-old age group is to

expand their awareness or develop generativity - that is, a sense of moving
away from themselves and becoming involved with the world of
community.
People who are having a child after age 40 years tend to fall into one of two
groups:
Those who are having their final child and;
Those who have delayed childbearing because of education or a career
and are having their first child.
ASSESSMENT
Health History
Family Profile
Day History
Physical Examination
Chromosomal Assessment
PREGNANCY EDUCATION
Nutrition
Prenatal Classes
COMPLICATIONS OF
PREGNANCY
Complications of pregnancy most likely to occur in a patient

over age 40 years - gestational hypertension, preterm or
postterm birth, and cesarean birth- are related to the fact that
the circulatory system may not be as competent as a younger
person’s or the body tissues may not be as elastic as they once
were.
COMPLICATIONS OF
PREGNANCY
“The older you get, the fewer eggs you have as you age; the lower odds of
conception...if you do get pregnant, the older the eggs you have, the more
likely you they have abnormal chromosomes.”
WHY?
The peak reproductive years span the time between your late teens and late
20s.
Fertility will begin to go down around age 30.
The process continues more quickly starting in your mid-30s.
Once you reach 45, your fertility will usually be so low that a natural
pregnancy is unlikely for most people.
COMPLICATIONS OF
PREGNANCY
GESTATIONAL HYPERTENSION
A patient over age 40 years has a higher risk of gestational hypertension than
a younger person because of blood vessel inelasticity, because hypertension
tends to occur more frequently in nulliparas then in multiparas, and because
some degree of hypertension may already exist before pregnancy.
At any age, the best way to reduce the symptoms of gestational hypertension
is to take in an adequate supply of protein and obtain adequate rest each day.
COMPLICATIONS OF
PREGNANCY
GESTATIONAL HYPERTENSION
Other complications include:
Pre Eclampsia
Gestational Diabetes
Placenta Previa
Miscarriage
(Chances of having a child with down syndrome)
(Chances of having twins/triplets)
COMPLICATIONS OF LABOR, BIRTH, AND
THE POSTPARTUM PERIOD
Failure to progress in labor

Labor in older primipara may be prolonged due to the fact
that cervical dilatation may not occur as spontaneously as it
does in younger women.
Difficulty accepting the event

Women over age 40 years may begin to have second thoughts
about childbearing this late in life as the reality of a new baby
registers with them during the intrapartal and postpartum
periods.
COMPLICATIONS OF LABOR, BIRTH, AND
THE POSTPARTUM PERIOD
Postpartum hemorrhage
Due to inelasticity, cervix may not dilate readily during labor,
and the uterus may not contract readily in the postpartum
period. Which puts women over 40, at higher risk for
postpartum hemorrhage (Debost-Legrand, A., Rivière, O.,
Dossou, M., et al., 2015).
Thank You!!

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THE PREGNANT ADOLESCENT

AND PREGNANCY OVER 40

1 Limited or Lack or appropriate sex education in public schools.

2 Lack of knowledge about (or failure to use ) contraceptives or abstinence.

3 Lack of access to contraceptives based on state laws or insurance coverage.

4 Parental limitation of adolescent’s access to contraceptives.

5 Desire by adolescents to have a baby.

Adolescence is a vulnerable time for pregnancy because the

The developmental task of the average adolescent are fourfold:

Adolescent are considered high-risk patients because they have

Adolescent also have a higher incidence of low-birth-weigth

FACTORS CONTRIBUTING TO THE LACK OF PRENATAL CARE:

Plans for the baby

Inability to Adapt Postpartally

Lack of Knowledge About Infant Care.

The developmental challenge of the over-40-year-old age group is to

Complications of pregnancy most likely to occur in a patient

Other complications include:

Failure to progress in labor

Difficulty accepting the event

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