 When a woman enters pregnancy with a chronic condition such as

cardiovascular, or kidney disease, both she and the fetus can be at risk for
complications because either the pregnancy can complicate the disease or the
disease can complicate the pregnancy affecting the baby or leaving a woman
less equipped to function in the future or undergo a future pregnancy
 In addition to pre-existing illnesses, the pregnant woman like any person may
develop new illness during pregnancy which can adversely affect not only the
woman but her unborn child.
 When accidents and illness occur despite precautionary measures, nursing care
focuses on
 Preventing such disorders from affecting the health of the fetus
 Helping a woman regain her health as quickly as possible so she can continue a
healthy pregnancy and prepare herself psychologically and physically for labor and
birth and the arrival of her newborn
 Helping a woman learn more about her chronic illness so she can continue to
safeguard her health during her childrearing years
High Risk
 Is one in which a concurrent disorder, pregnancy
related complication, or external factor
jeopardizes the health of the woman, the fetus or
both.
 One in which some condition puts the mother, the
developing fetus, or both at higher-than-normal
risk for complications during or after the
pregnancy and birth.
Causes
 Related to the pregnancy itself when they exist in pregnancy
 Occurs because the woman has a medical condition
 Results from environmental hazards
 Arise from maternal behavior or lifestyle
 Poverty
 Lack of support people circumstances that
 Poor coping mechanisms causes women to be
 Genetic inheritance high-
risk
 Past history of pregnancy complications
 Should be seen more frequently for prenatal care
DEMOGRAPHIC FACTORS
Maternal Age (<18 or >35 years)
 
 
 
 
 
 
Poverty
Maternal Parity/ mulitiparity ( >4
pregnancies)
EFFECTS
Less than 18: increased risk for LBW and
preterm labor, PIH, anemia, Cesarean
Section for CPD.
More than 35 years: increased risk of
chromosomal abnormalities, PIH, placenta
previa , H- Mole, CHVD Babies with
chromosomial abnormalities
Associate with LBW, preterm infants
Hemorrhage, CS and fetal loss/ abortion
PERSONAL-SOCIAL FACTORS

1. Weight <100 lbs: associated with LBW

>200 lbs: PIH, LGA infants, difficult labor,
CS due cpd

2. Height ( <5 feet) Increased risk for CS due to CPD

3. Smoking LBW, preterm birth

4. Alcohol/illegal drug use Congenital anomalies, fetal withdrawal
Lifestyle & Occupation syndrome, fetal alcohol syndrome
What she consumes & what she is exposed  
to can seriously affect her pregnancy
Ex. a. OTC drugs
5. Substance abuse
 Obstetric factors& Gynecologic HX

EFFECTS

Birth of previous infant with weight >8.5 Increased risk for CS, birth injury, maternal
lbs/ 2 or more premature deliveries/ gestational diabetes and neonatal
abortions hypoglycemia
   
Previous stillbirth Increased risk of maternal psychological
  distress
Rh sensitization  Increased risk for fetal anemia,
  eryhroblastosis and kernicterus
Cervical insufficiency /cervical Associated with delivery of previable fetus
incompetency  
Multiple gestations/ pregnancies Associated with nutritional anemia,
 malposition preeclampsia, preterm labor,
malpresentation malpresentation, CS, postpartum hemorrhage
previous dystocia
placental abnormalities etc
 Existing medical conditions /Maternal Medical History

EFFECTS

DM Increased risk of PIH. CS, LGA, SGA ,

neonatal hypoglycemia, fetal or neonatal
death, congenital anomalies

Hypothyroidism Increased risk of spontaneous abortion,

  congenital anomalies, congenital
hypothyroidism

Cardiac disease Increased risk of fetal or neonatal death

Watch out for signs of worsening heart
disease such as edema, crackles, activity
intolerance, and irregular heart rate

Renal disease Associated with maternal renal failure,

preterm delivery, intrauterine growth
retardation
 Concurrent infection Severe fetal effects if maternal disease
occurs in the first trimester
Increased risk for spontaneous abortion and
congenital anomalies

Seizure disorders Increased risk of fetal malformation,

increased incidence of cerebral palsy, seizure
disorder and mental retardation in offspring

Liver disease Preterm and stillbirths

Environmental agents
Impair fertility, interfere with normal
placental function and may be toxic to the
fetus leading to fetal death
FACTORS THAT CATEGORIZES
CLIENT TO BE HIGH-RISK
PSYCHOLOGICAL
History of drug dependence
(including alcohol)
History of intimate partner
abuse
History of mental illness
History of poor coping
mechanisms
Cognitively challenged
Survivor of childhood sexual
abuse
SOCIAL
Occupation involving
handling of toxic, substances
(including radiation and
anesthesia gases)
Environmental contaminants
at home
Isolated
Lower economic level
Poor access to transportation
for care
High altitude
Highly mobile lifestyle
Poor housing
Lack of support people
PHYSICAL
Visual or hearing challenges
Pelvic inadequacy or
misshape
Uterine incompetency,
position or structure
Secondary major illness
(heart disease, diabetes
mellitus, kidney disease,
hypertension. Chronic
infection such as
tuberculosis, hemopoietic or
blood disorder, malignancy)
PSYCHOLOGICAL SOCIAL PHYSICAL
Poor gynecologic or obstetric
history
History of previous poor
pregnancy outcome
(miscarriage, stillbirth,
intrauterine fetal death)
History of child with
congenital anomalies
Obesity ( BMI >30)
Underweight ( BMI <18.5)
Pelvic inflammatory disease
History of inherited disorder
Small stature
Potential of blood
incompatibility
Younger than age 18 years or
older than 35 years
Cigarette smoker
Substance abuser
Psychological SOCIAL PHYSICAL
Loss of support person Refusal of or neglected Fluid or electrolyte
Illness of a family member prenatal care imbalance
Decrease in self esteem Exposure to environmental Intake of teratogen such as a
Drug abuse ( including teratogens drug
alcohol and cigarette Disruptive family incident Multiple gestation
smoking) Conception less than 1 year A bleeding disruption
Poor acceptance of after last pregnancy Poor placental formation or
pregnancy position
Gestational diabetes
Nutritional deficiency of
iron, folic acid, or protein
Poor weight gain
Pregnancy-induced
hypertension
Infection
Amniotic fluid abnormality
Postmaturity
PSYCHOLOGICAL
Severely frightened by labor
and birth experience
Inability to participate
because of anesthesia
Separation of infant at birth
Lack of separation for labor
Birth of infant who is
disappointing in some way
(such as sex, appearance, or
congenital anomalies)
Illness in newborn
SOCIAL PHYSICAL
Lack of support person Hemorrhage
Inadequate home for infant Infection
care Fluid and electrolyte
Unplanned cesarean birth imbalance
Lack of access to continued
health care
Lack of access to emergency
personnel or equipment
VULNERABLE GROUPS OF PREGNANT
WOMEN
 Adolescent

 Mentally ill

 18 y/o and below

 Women over 40 y/o

 Physically and cognitively challenge

 Woman who is a substance dependent

1. UTZ: abdominal, transvaginal, Doppler
UTZ – 18-20 weeks detect gross anomalies
2. Bioprofile = 36-38 weeks
 Biophysical profile- uses ultrasonography and NST to assess 5
biophysical variables in determining fetal well being.
 Performed during a 30 minute time frame
 NST – assessing for FHR acceleration in relation to fetal movements
 Amniotic fluid index – assessning for one or more pockets of amniotic fluid
measuring ¾ inch (2 cm) or more in 2 perpendicular planes.
 Gross fetal body movements- one or more episodes lasting at least 30
seconds.
 Fetal juscle tone – one or more active extension with return to flexion of
spine, hand or limbs.
3. Amniocentesis = for L/S ratio
- done between 14-16TH weeks
 Invasive procedure for amniotic fluid analysis to
assess fetal lung maturity done after 14 weeks
gestation
4. NST
 Reactive test – 3 accelerations of FHR 15 beats/min
above baseline FHR lasting for 15 sec. Or more, over
20 minutes
 Non reactive test – no accelerations or acceleration less
than 15 beats/ minute above baseline FHR. May
indicate fetal jeopardy.
5. AFI (amniotic fluid index) – the sum of the
amniotic fluid in the quadrants of the uterus
6. Kick count assessment tool: Sandovsky or Cardiff
method - usually done after meal
10 movements per hour
7. AFP (amniotic fetoprotein) – to detect neural
tube defects, done at 15-20 weeks
8. Diabetic screening - done at 24-28 weeks
9. Percutaneous blood sampling/ cordocentesis
10. MSAFP- maternal serum alpha fetoprotein –
done to detect neural tube defects or open
abdominal wall defects
Done between 16-18 weeks
11. Sickle cell test – done to detect presence of sickle
hemoglobin in at risk women.
12. Group B beta Streptococcus (cervical and pharyngeal
swabs) – done to detect carriers or active group B beta
streptococcus.
13. BASIC LAB TEST
 Blood screening for Rh actor
 VDRL for sedone at 32 weeks
 Urine testing/ Urinalysis
 Pap’s smear for STD
 Stool culture for ova and parasites
 To test for high risk patient
DANGER SIGNS OF PREGNANCY
 Pain
 Persistent vomiting
 Sudden gush of fluid from the vagina
 Headache
 Vaginal bleeding
 Blurred vision
 Dizziness
 Chills and fever over 38C ( 100.4F)
 Painful urination