HIGH-RISK PREGNANCY WITH GRAND MULTIPARITY AND PREVIOUS OBSTETRIC COMPLICATIONS: A CASE REPORT
Abstract
High-risk pregnancy in women with advanced maternal age, grand multiparity, and a history of placenta previa and precipitous labor increases the risk of maternal and fetal complications. This case report aimed to describe the implementation of risk -based midwifery care and maternal outcomes in a high-risk pregnancy. A case report was conducted involving a 44-year-old woman (G5P4A0) at 27 weeks of gestation with a history of placenta previa and precipitous labor. Midwifery care was provided at Ngrambe Public Health Center, Ngawi Regency, Indonesia, from March to April 2026 using the SOAP approach, including risk assessment, regular antenatal monitoring, laboratory and ultrasound examinations, health education, psychological support, birth preparedness and complication prevention (P4K), and postpartum family planning counseling. The patient was classified as having a high-risk pregnancy with a KSPR score of 10. During follow-up until 36–37 weeks of gestation, maternal and fetal conditions remained stable without antepartum hemorrhage, hypertension, preeclampsia, anemia, fetal growth restriction, or recurrent precipitous labor. Maternal fatigue, decreased appetite, and lower-limb edema improved following individualized non -pharmacological interventions. The patient demonstrated good adherence to antenatal care, increased psychological readiness for childbirth, and chose permanent contraception (MOW) for postpartum family planning. Risk-based midwifery care with early risk assessment, continuous monitoring, individualized education, and family involvement contributed to favorable maternal and fetal outcomes in this high-risk pregnancy.Keywords
Grand multiparity, advanced maternal age, placenta previa, precipitous labor
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