Assessing Obstetrical

Risk Factors
in a Rural Setting
Unit 3
NUR 337

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 Lecture Overview
 Overview of risk factors
 Genetic risk factors
 Demographic risk factors
 Occupational hazards
 Behavioral characteristics
 Multiple gestation

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 Risk Factors for
Complications
Assessment of the mother antenatally should include questions
regarding the following topics:
1) Pre-pregnant health status
2) Obstetrical history
3) Nutritional insufficiency
4) Prescription and over-the-counter medication use
5) Domestic Violence
6) Personal or Family hx of psychiatric disease including
depression

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 Risk Factors (cont)
7) Occupational Hazards

8) Preterm risk factors –detail later

9) Gestational diabetes risk factors-detail later

10) Modifiable infection risks-rubella/ TB/malaria/HIV/STI’s

11) Substance use

12) History of genetic abnormalities

13) Are the parents related in any way?

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 Activity
 How would you word questions for points 1-6, 10-13?
 Work in pairs
 Write down 3 questions for each, then share with the
class

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 Genetic Risk
 All pregnancies carry a 5% risk for a congenital
abnormality.
 Who is most at risk?

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 Population at Risk for Genetic
Disorders
 Maternal age over 35
 Positive family history
 Southeast Asian descent-(Thalassemia)
 Previous child with genetic defect
 Maternal PKU or CHD
 Maternal history of 2 or more miscarriages
 Extreme parental anxiety/concern

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 Demographic Risk Factors
 Geographic Location
 Socioeconomic Status
 Educational Attainment
 Marital Status
 Maternal Age
 Occupational Hazards

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 Chemical Risks Factors
Cause Effect
Mercury Spontaneous abortion
Low birth weight
Cognitive impairment

Lead Fetal death

Impaired neurological development

Second hand smoke Low birth wt

Pesticide Decreased fertility

Congenital Abnormalities

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 Physical Risks Factors
Cause Effect
Physically Demanding Work Possible preterm birth
Small gestational age
Pre-eclampsia

Severe Fatigue Prematurity

Low birth weight

Extreme Heat Spontaneous Abortion

(core temp 38.9 or > Birth defects

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 Physical Risks Factors (cont)
Cause
A constant noisy envoronment
Long term exposure to vibration
Effect
Decreased fertility
Congenital anomalies
Preterm labor
SGA
Decreased fertility
Spontaneous abortion
Preterm labor
Hyperemesis gravidarum

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 Biological Risks Factors
 Contact in crowded places or work in high risk area
may result in exposure to infectious diseases such as:
 Chicken pox
 Rubella, Measles
 TD
 Diphtheria
 Pertussis
 Malaria
 Dengue
 Typhoid

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 Biological Exposure
 May lead to:
 Congenital anomalies
 Congenital disease
 Premature rupture of membranes
 Miscarriage
 Stillbirth

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 Psychological Risk Factors
 Extreme stress can result in
 Spontaneous abortion
 Prematurity
 Gestational hypertension

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 Case Study
Tasa is a 19 year old girl who works in a textile plant
outside of Dhaka. She is 16 weeks pregnant and works
12 hours days. Tasa works in a very noisy and fast paced
environment and stands on her feet all day. She walks to
and from work which takes her 30 minutes each way. By
the time she arrives home she is too tired to eat much.
She often eats just rice and dahl. This is her 2nd
pregnancy.

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 Activity
 What Occupational Risk Factors can you identify?

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 Behavioral Characteristics
 Behavioral Characteristics are actions the mother
takes, or does not take

 Are an important component of an antenatal

assessment to help identify risks that may lead to a
complication in pregnancy.

 Which behavioral characteristics would you assess for?

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 Behavioral Characteristics
Assess for the following:
 Substance abuse
 Failure to seek prenatal care
 Nutritional status-unintentional or intentional
malnourishment
 Dental hygiene
 Vaccination status
 Hx of abuse and violence
 Exposure to sexually transmitted diseases

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 Multiple Gestation
A woman that is carrying more than 1 fetus is at risk for
physiologic and psychological risks:

 Preterm labor
 Pregnancy induced hypertension
 Fetal growth restriction and low birth weight
 Maternal anemia
 Discomfort

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 Multiple Gestation (cont)
 Parental distress
 Child abuse
 Marital breakdown
 Substance abuse
 Antenatal and postnatal depression

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 Questions?

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 References
Fraser, D.M., & Cooper, M.A. (2009). Myles Textbook for
Midwives 15th ed. London: Churchill Livingstone
Elsevier.

Klein, S., Miller, S. & Thomson, F. (2004). A Book for

Midwives: Care for pregnancy, birth and women’s
health. California, USA: Hesparian Foundation

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