HIGH RISK PREGNANCY

1. Define
- A "high-risk" pregnancy means a woman has one or more things that raise her — or
her baby's — chances for health problems or preterm (early) delivery.

2. Demographic factors associated with high risks pregnancy.

- Age - Women who will be under age 17 or over age 35 when their baby is due are at
greater risk of complications than those between their late teens and early 30s.
- Employment and Income - Low income pregnant women present disproportionately
high rates of nutritional risk, inadequate GWG, and low breastfeeding rate
- Education – Without proper education, may cause poor understanding regarding
pregnancy.

3. Identify the integrated socio-economic factors associated with high risks pregnancy.
- Educational attainment – Lack of education contributes to teen pregnancy in low-
and lower-middle-income countries.
- Poverty - Poverty limits freedom, opportunities, and resources and creates
conditions for powerlessness,
- exclusion and vulnerabilities. Such vulnerabilities can create increased conditions for
lack of education and teenage pregnancy.
- Occupation - High psychological work stress has been associated with increased risk
of miscarriage, lower birth weight and preterm delivery.

4. What are the data needed for obstetric history for high risks pregnancy?
Term Pregnancies
 For each previous pregnancy carried beyond 24 weeks, inquire about
the following:
 Gestation – previous preterm labor is a risk factor for subsequent
preterm labor.
 Mode of delivery – spontaneous vaginal, assisted vaginal or
Caesarean.
 Gender
 Birth weight – a previous small for gestational age (SGA) baby
increases the risk of a subsequent one.
 Complications – e.g. pre-eclampsia, gestational hypertension,
gestational diabetes, obstetric anal sphincter injury (3rd, 4th degree
tears), post-partum hemorrhage.
 Assisted reproductive therapies (ART) – e.g. ovulation induction with
clomiphene, IVF.
 Care providers – was the patient’s care completely with a midwife or
was there previous obstetric input, if so, why
For ectopic pregnancies, ask about:
 Site of the ectopic
 Management: expectant (monitoring of serum hCG levels), medical
(methotrexate injection), surgical (laparoscopy or laparotomy;
 salpingectomy (removal of tube) or -otomy (cutting of tube and
suctioning of trophoblastic tissue))

5. What are the data needed for current OB status for high-risk pregnancy?
Specific data for OB Status that might contribute to a high-risk pregnancy include:
o Advanced maternal age. Pregnancy risks are higher for mothers older than
age 35.
o Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs
can put a pregnancy at risk.
o Maternal health problems. High blood pressure, obesity, diabetes, epilepsy,
thyroid disease, heart or blood disorders, poorly controlled asthma, and
infections can increase pregnancy risks.
o 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.
o Multiple pregnancy. Pregnancy risks are higher for women carrying twins or
higher order multiples.
o 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 have 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.

6. What are the relevant maternal medical history?

- The last normal menstrual period (LMP)
- Past obstetric history
- General examination
- Examination of the thyroid gland
- Examination of the breasts
- Examination of the lymph nodes
- Examination of the cardiovascular system

7. What are the habits or habituation associated with high-risk pregnancy?

- Consumption habits – Less or more than the required nutrition may affect pregnancy.
- No physical activity – Less or more of the required exercise may affect pregnancy.
- Drugs, Cigarettes and Alcohol intake – It may cause birth defects, developmental
impairment and health issues for baby and mother.
- Skipping prenatal visits – The mother will miss especially important information
regarding their health and the developing baby.
- Not taking prenatal vitamins - They contain nutrients that help make up for any diet
deficiencies.