Identifying High risks pregnancy

A high-risk pregnancy is one in which a concurrent disorder, pregnancy-related complication, or external

factor jeopardizes the health of the woman, the fetus, or both. Some women enter pregnancy with a
chronic illness that, when superimposed on the pregnancy, makes it high risk. Other women enter
pregnancy in good health but then develop a complication of pregnancy that causes it to become high
risk. In some instances, a combination of particular circumstances—poverty, lack of support people,
poor coping mechanisms, genetic inheritance, or past history of pregnancy complications—can cause a
pregnancy to be categorized as high risk. In most instances, more than one factor contributes to the
classification of a pregnancy this way. The pregnancy of a woman who is diabetic, for example, is
automatically termed one with greater than normal risk because it forces a fetus to grow in an
environment in which hyperglycemia (increased serum glucose levels) becomes the rule. During such a
pregnancy, a woman, worrying that something will happen to her baby, may fail to begin the “pregnancy
work” that she must do so bonding can take place. At birth, her child is in double jeopardy: not only is
the baby born with altered glucose metabolism, but he or she also is at high risk for poor maternal–child
attachment. A preterm infant born to a teenage girl, likewise, could have this double problem. Not only
is the infant immature (and at risk for all the complications that accompany immaturity), but also he or
she may have a mother who is immature as well (see Chapter 22 for discussion of the special needs of
the pregnant adolescent). Table 20.1 lists psychological, social, and physical factors that commonly
cause a pregnancy to be categorized as high risk. Categorizing risks as minimal, moderate, or extensive
differs with each woman because of her individual coping mechanisms and level of support. A woman
living in extreme poverty who does not have access to community support, for example, would be at
high risk for poor nutritional intake during pregnancy, whereas a woman with a similar income who
could depend on a nutritional assistance program such as WIC and counseling from a community health
nurse might be only at minimal risk. Remembering that the term “high risk” rarely refers to just one
causative factor helps in the planning of holistic and ultimately effective nursing care. Pre-existing or
newly acquired maternal illnesses that can make a pregnancy high risk are discussed in this chapter.
Chapter 21 discusses conditions specific to pregnancy that can make a pregnancy high risk. Chapter 22
covers populations that are at high risk because of age (younger than 18 years or older than 40 years),
the presence of a disability or trauma, or drug abuse.