NAME: Rica Machells C.

Dayda DATE: 2/15/21

Year/Section: BSN-II

1. Define High Risk Pregnancy

-A high-risk pregnancy is one of greater risk to the mother or her fetus than an uncomplicated
pregnancy. Pregnancy places additional physical and emotional stress on a woman’s body. Health
problems that occur before a woman becomes pregnant or during pregnancy may also increase the
likelihood for a high-risk pregnancy.

If you have a high-risk pregnancy, you or your baby might be at increased risk of health
problems before, during or after delivery

Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy.
In other cases, a medical condition that develops during pregnancy for either you or your baby
causes a pregnancy to become high risk.
Specific factors that might contribute to a high-risk pregnancy include:
Advanced maternal age. Pregnancy risks are higher for mothers older than age 35.
Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a
pregnancy at risk.
Maternal health problems. High blood pressure, obesity, diabetes, epilepsy, thyroid disease,
heart or blood disorders, poorly controlled asthma, and infections can increase pregnancy risks.
Pregnancy complications. Various complications that develop during pregnancy can pose risks.
Examples include an abnormal placenta position, fetal growth less than the 10th percentile for
gestational age (fetal growth restriction) and rhesus (Rh) sensitization — a potentially serious
condition that can occur when your blood group is Rh negative and your baby's blood group is
Rh positive.
Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order
multiples.
Pregnancy history. A history of pregnancy-related hypertension disorders, such as
preeclampsia, increases your risk of having this diagnosis during your next pregnancy. If you
gave birth prematurely in your last pregnancy or you've had multiple premature births, you're at
increased risk of an early delivery in your next pregnancy. Talk to your health care provider
about your complete obstetric history.
 2. Identify the demographic factors associated with high-risk
pregnancy.

1) High blood pressure

Even though high blood pressure can be risky for mother and fetus, many women with high blood
pressure have healthy pregnancies and healthy children. Uncontrolled high blood pressure, however, can
lead to damage to the mother’s kidneys and increases the risk for low birth weight or preeclampsia.

2) Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a disorder that can interfere with a woman's ability to get and stay
pregnant. PCOS may result in higher rates of miscarriage (the spontaneous loss of the fetus before 20
weeks of pregnancy), gestational diabetes, preeclampsia, and premature delivery.

3) Diabetes
It is important for women with diabetes to manage their blood sugar levels before getting pregnant. High
blood sugar levels can cause birth defects during the first few weeks of pregnancy, often before women
even know they are pregnant. Controlling blood sugar levels and taking a multivitamin with 400
micrograms of folic acid every day can help reduce this risk.

4) Kidney disease
Women with kidney disease often have difficulty getting pregnant, and any pregnancy is at significant
risk for miscarriage. Pregnant women with kidney disease require additional treatments, changes in diet
and medication, and frequent visits to their health care provider.

5) Autoimmune disease
Autoimmune diseases include conditions such as lupus and multiple sclerosis. Some autoimmune diseases
can increase a women's risk for problems during pregnancy. For example, lupus can increase the risk for
preterm birth and stillbirth. Some women may find that their symptoms improve during pregnancy, while
others experience flare ups and other challenges. Certain medications to treat autoimmune diseases may
be harmful to the fetus as well.

6) Thyroid disease
Uncontrolled thyroid disease, such as an overactive or underactive thyroid can cause problems for the
fetus, such as heart failure, poor weight gain, and birth defects.

7) Recreational Drugs
Several studies have found that women who take drugs that increase the chances of pregnancy are
significantly more likely to have pregnancy complications than those who get pregnant without
assistance. These complications often involve the placenta (the organ linking the fetus and the mother)
and vaginal bleeding.

8) Obesity
Obesity can make a pregnancy more difficult, increasing a woman’s chance of developing diabetes during
pregnancy, which can contribute to difficult births. On the other hand, some women weigh too little for
their own health and the health of their growing fetus. In 2009, the Institute of Medicine updated its
recommendations on how much weight to gain during pregnancy. New recommendations issued by the
American College of Obstetricians and Gynecologists suggest that overweight and obese women may be
able to gain even less than what is recommended and still have a healthy infant.

9) HIV/AIDS
HIV/AIDS damages cells of the immune system, making it difficult to fight infections and certain
cancers. Women can pass the virus to their fetus during pregnancy; transmission also can occur during
labor and giving birth or through breastfeeding. Fortunately, effective treatments exist to reduce the
spread of HIV from the mother to her fetus, newborn, or infant. Women with very low viral loads may be
able to have a vaginal delivery with a low risk of transmission. An option for pregnant women with
higher viral loads (measurement of the amount of active HIV in the blood) is a caesarean delivery, which
reduces the risk of passing HIV to the infant during labor and delivery. Early and regular prenatal care is
important. Women who take medication to treat their HIV and have a cesarean delivery can reduce the
risk of transmission to 2%.

10) Age
Pregnant teens are more likely to develop high blood pressure and anemia (lack of healthy red blood
cells), and go into labor earlier than women who are older. Teens also may be exposed to a sexually
transmitted disease or infection that could affect their pregnancy. Teens may be less likely to get prenatal
care or to make ongoing appointments with health care providers during the pregnancy to evaluate risks,
ensure they are staying healthy, and understand what medications and drugs they can use.

11) First-time pregnancy after age 35

Older first-time mothers may have normal pregnancies, but research indicates that these women are at
increased risk of having: a cesarean delivery; delivery complications, including excessive bleeding during
labor; prolonged labor (lasting more than 20 hours); Labor that does not advance; an infant with a genetic
disorder, such as Down syndrome.

3. Identify the interrelated socio economic factors associated

with high risk pregnancy.
In pregnant women, low SES can increase the risk of adverse pregnancy outcomes.
Previous studies have revealed that low SES is associated with pregnancy
complications such as abortion, preterm delivery, preeclampsia, eclampsia, and
gestational diabetes.
Social and economic factors, such as income, education, employment, community
safety, and social supports can significantly affect pregnancies. These factors affect our
ability to make healthy choices, afford medical care and housing, manage stress, and
more.

 Income
 Education
 Employment
 Community Safety
 Social Support
 Low economic level
 Poor access to transportation
 Poor housing
 Refusal or neglected prenatal care
 Disruptive family incident
 Conception less than one year after last pregnancy
 Inadequate home for infant care
 Lack of access to continued health care
 Occupation involving handling of toxic materials
 Environmental contaminants
 Isolated
 Low economic level
 Poor access to transportation
 Poor housing
 Refusal or neglected prenatal care
 Disruptive family incident
 Conception less than one year after last pregnancy
 Lack of support person
 Inadequate home for infant care
 Lack of access to continued health care

4. A. What are the data needed for obstetric history for high risk
pregnancy.

PAST OBSTETRIC HISTORY INCLUDES:

• Details of all previous pregnancies (including miscarriages and terminations).
 •Length of gestation.
• Date and place of delivery.
• Onset of labor (including details of induction of labor).
• Mode of delivery.
• Sex and birth weight.
• Fetal and neonatal life.
• Clear details of any complications or adverse outcomes (such as shoulder dystocia,
postpartum hemorrhage, or stillbirth).
• History often repeats itself, so previous antenatal, intrapartum, or postpartum
complications should influence the management of this pregnancy.

B. What are the data needed for current OB status for high
risk pregnancy.
HISTORY OF CURRENT PREGNANCY
• 1st trimester
• Second trimester
• Third trimester
• History of labor HISTORY OF IST TRIMESTER
• method of confirmation of pregnancy, LMP • General health (tiredness, malaise,
and other non-specific symptoms)
• Bleeding, pain. (Ectopic pregnancy, miscarriage)
• Vaginal discharge
• Hyperemesis
• Urinary problems
• Investigations (ultrasound, blood and urine test ) drug history (treatment)
• Vaccination HISTORY OF SECOND & THIRDTRIMESTER
• History of fetal movements
• Symptoms of anemia, Miscarriage, Ectopic pregnancy, Vaginal discharge, UTI,
hyperemesis gravidarum
• Symptoms of aph,pih.diabetes, preterm labor
• Ask for vaccination
• Results of all antenatal blood tests-routine and specific.
• Results of anomaly and other scans (details of results can be cross checked with
the notes).
IF SHE IS POSTNATAL:

• Labor and delivery

• History of the postnatal period.

C. What are the relevant maternal medical history

Maternal obesity

Obesity is increasing globally and obesity in pregnancy can be problematic for the mother,
leading to:
 blood clotting disorders
 gestational diabetes (see below)
 high blood pressure (see below)
 obstructed labour (such as shoulder dystocia, where the baby’s shoulder becomes caught
under the mother’s pubic bone during birth)
 postpartum haemorrhage (excessive blood loss following the baby’s birth)
 a need for instrumental delivery and caesarean section
 a higher incidence of congenital problems, prematurity, stillbirth and childhood obesity
(Kain & Mannix, 2018).

Gestational diabetes mellitus (GDM)

With obesity on the rise, the incidence of GDM is also growing. GDM can affect the
newborn in a number of ways, including:
 low birthweight
 large birthweight (macrosomia)
 birth trauma (if the baby is large) and
 metabolic, cardiovascular and neurological disorders (Nodine et al, 2016).
Maternal hypertension (high blood pressure)

 When the mother has high blood pressure, it can reduce blood flow in the placenta. This
is referred to as vasoconstriction (constriction of the blood vessels) of the uteroplacental
circulation. It can result in the baby being born small for its gestational age (SGA) and
can also increase the risk for stillbirth (Kain & Mannix, 2018).

Maternal infections

 Viral infections in the mother are well-known teratogens (agents or factors, which cause

malformation in the embryo). Viral maternal infections can lead to chorioretinitis (an
inflammation of the retina of the eye), hearing loss, seizures, bleeding problems, jaundice
and rash in the newborn.
 Bacterial infections – in particular Group B streptococcus (GBS) are the most common
bacterial infection. GBS infection in the newborn can result in respiratory distress and
sepsis (Kain & Mannix, 2018).

Medications taken by the mother

 In an ideal world, the woman’s pregnancy would be drug free. In reality, most mum’s-to-
be will take some form of medication, however most do not cause any harm to the
newborn. Drugs such as antidepressants are common in the West these days, and
antidepressants such as selective serotonin reuptake inhibitor (SSRI) drugs have only
mild adverse effects on the fetus. The pregnant woman should always check with her care
provider and/or pharmacist before taking medications during pregnancy.

Past Medical History

Ask the usual questions about past medical history, abdominal or pelvic surgery and mental
health conditions. Remember that the medical co-morbidities that are most likely to affect
women of childbearing age include:
 Asthma
 Cystic fibrosis
  Epilepsy
 Hypertension (older women)
 Congenital heart disease
 Diabetes – check if type 1 or type 2
 Systemic autoimmune disease e.g. systemic lupus erythematosus (SLE), rheumatoid
arthritis
 Haemoglobinopathies: sickle-cell disease, thalassaemias
 Blood-borne viruses: HIV, hepatitis B, hepatitis C

5. What are the habits or habituation associated with high risk

pregnancy?
Alcohol use
Alcohol consumed during pregnancy passes directly to the fetus through the umbilical
cord. The Centers for Disease Control and Prevention recommend that women avoid alcoholic
beverages during pregnancy or when they are trying to get pregnant. During pregnancy, women
who drink are more likely to have a miscarriage or stillbirth. Other risks to the fetus include a
higher chance of having birth defects and fetal alcohol spectrum disorder (FASD). FASD is the
technical name for the group of fetal disorders that have been associated with drinking alcohol
during pregnancy. It causes abnormal facial features, short stature and low body weight,
hyperactivity disorder, intellectual disabilities, and vision or hearing problems.
Cigarette smoking
Smoking during pregnancy puts the fetus at risk for preterm birth, certain birth defects,
and sudden infant death syndrome (SIDS). Secondhand smoke also puts a woman and her
developing fetus at increased risk for health problems.