HIGH RISK PREGNANCY

ASSESSMENT OF RISK FACTORS

 A concurrent disorder, pregnancy-related complication, or external factor jeopardizes the
health of the woman, the fetus or both
o Existing chronic illness
o Developed complications during pregnancy
 There is an increased chance for mortality and morbidity for both the mother and the fetus
 Factors that predisposes pregnant woman to high-risk pregnancy (Pilliteri, 2010)
a. Poverty
b. Lack of support people
c. Poor coping mechanism
d. Genetic inheritance
e. Past history of pregnancy complications
 Essential High-Risk factors (DR. RP’S 2009)
A. Demographic factors
1. Maternal age: under 18 and above 35
2. Pre-pregnant weight: under 90 lbs and 150 lb and above
3. Height: 5 ft
4. Family history of severe inherited disorders
B. Maternal habits
1. Smoking
2. Alcohol
3. Drug addiction
4. Food fads
C. Socio economic factors
1. Low socio-economic status
a. Poor nutrition
b. Poor finances
c. Poor housing
d. Parental occupation
2. Unwed condition/marital status
3. Poor support system
D. Maternal obstetric factors: past and present
1. History of infertility
2. Primigravidity/grand multiparity
3. Birth interval
4. Late or no prenatal care
5. Rh sensitization
6. Past or present obstetric complication:
a. Abortion
 b. Ectopic pregnancy
c. Placenta previa/abruption placenta
d. PIH
e. Multiple gestation
f. Premature/postmature labor
g. Premature rupture of bag of water
h. Maternal anemia
i. Dystocia/precipitate labor
j. Abnormal presentation/breech
k. Operative OB: cesarean section
l. Fetus inappropriately small of large for age
m. Still birth/neonatal death
n. Polyhydramnios
E. Maternal medical history, including coincidental diseases of pregnancy
1. Cardiac disorder/history of rheumatic fever in childhood
2. Metabolic disease: DM/thyroid disorder
3. Chronic hypertension/renal disorder: UTI, bacteriuria
4. Pulmonary disease
5. Venereal and other infectious disease
6. Malignancy
7. Mental retardation/severe emotional instability
8. Congenital anomalies of the reproductive tract
F. Maternal surgical history/status
1. Previous CS
2. Other reproductive tract surgery
What causes a high-risk pregnancy?
Many factors can make a pregnancy high-risk.

Some health conditions can make your pregnancy high-risk too. See a doctor before you start
trying to get pregnant if you have a chronic condition, so you can be as healthy as possible before
you conceive. There are many health conditions that affect pregnancy including:

 Blooddisorders. If you have a blood disorder, such as sickle cell disease or thalassemia, the
additional strain pregnancy puts on your body can make your condition worse. There are also
potential risks to your baby (both during pregnancy and after delivery) if she inherits your
condition.

 Chronickidney disease. This condition increases your risk of miscarriage, developing high blood
pressure and preeclampsia, and having your baby early. Pregnancy can also put an extra strain on
your kidneys.
 Depression. Pregnancy and becoming a mom can make you more vulnerable to mental health
problems, including anxiety and depression. Untreated depression and some medications for
depression are linked with risks for your baby. (However, don't make changes to your medication
without talking to your healthcare provider first. Stopping suddenly has risks too.)

 Highblood pressure. You can still have a normal pregnancy, even if you have high blood pressure.
However, untreated high blood pressure can cause your baby to grow more slowly than usual or
be born early. Other complications associated with high blood pressure include preeclampsia
and placental abruption, a serious condition in which the placenta partially or completely
separates from the uterus before a baby is born.

 HIV or AIDS. If you have HIV or AIDS, your baby can become infected before birth, during
delivery, or when you breastfeed. Fortunately, medication can dramatically reduce this risk.

 Lupus. Lupus and other autoimmune diseases can increase your risk of preterm delivery,
preeclampsia, and having a small baby. Being pregnant may also increase the likelihood of your
disease flaring up or getting worse.

 Maternal age. Your age can affect how likely you are to have a high-risk pregnancy. Being an
older mom (age 35 or older in your first pregnancy) or a younger one (in your teens) puts you at
greater risk of some complications and health problems.

 Obesity.Having a body mass index (BMI) of 30 or higher before pregnancy puts you at greater risk
of gestational diabetes, type 2 diabetes, and high blood pressure during your pregnancy. When it
comes to giving birth, you're more likely to need your labor induced or a cesarean delivery.

 Thyroid disease. Both an underactive thyroid (hypothyroidism) and an overactive thyroid

(hyperthyroidism) during pregnancy can cause problems for you and your baby if the condition
isn't controlled. These problems can include miscarriage, preeclampsia, low birth weight, and
having your baby early.

 Type 1or type 2 diabetes. If your diabetes isn't managed well, you could be at risk of
complications including birth defects, high blood pressure, having your baby early, and having a
very big baby (macrosomia). Your baby may have problems with breathing, low glucose levels,
and jaundice.

Addiction to cigarettes, alcohol, or drugs will increase your risk of pregnancy problems. Try to
be open and honest with your healthcare provider so she can help you access the support you
need:

 Alcohol. Heavy drinking during pregnancy exposes your baby to an increased risk of stillbirth and
fetal alcohol spectrum disorder (FASD).

 Smoking. If you smoke while you're pregnant, your baby is at risk of many complications including
being born small and being born early.
 Substance abuse. If you use illegal drugs or misuse prescription medication regularly your baby
may suffer from withdrawal symptoms after birth. He may have birth defects, have a low birth
weight, or be born early.

It's also possible to develop health problems for the first time during your pregnancy, even if
you're usually fit and healthy. These sorts of problems include:

 Birthdefects. About 3 in 100 babies born will have a birth defect. Some birth defects can be
detected by ultrasound or by genetic testing before birth. If a birth defect is suspected or
diagnosed, you and your baby will be followed more closely during pregnancy. Depending on
the defect, you may also need to give birth at a hospital with pediatric specialists available to care
for your baby immediately.

 Gestationaldiabetes. This is diabetes that develops during pregnancy. Gestational diabetes can be
controlled by following a diet and treatment plan that may include medication, such as insulin.
Uncontrolled gestational diabetes can put you at risk of a preterm birth, high blood pressure, and
preeclampsia.

 Growth problems. Your provider will track your baby's growth by measuring your belly at each
visit. In some cases, a baby doesn't grow as well as it should. If your baby's growth is too slow,
you may need extra monitoring, and you may need to have your baby early.

 Multiples.
If you're pregnant with twins or more, you'll have extra care during your pregnancy
because carrying more than one baby puts a strain on your body. Your babies can be at risk of
complications, especially being born early.

 Preeclampsia. This is a serious condition that occurs during the second half of pregnancy, in which
you develop high blood pressure and protein leaks into your urine. Preeclampsia can slow down
the rate of your baby's growth and affect your health. Giving birth is the only cure for
preeclampsia, so if you develop this condition you may need to have your baby early.

How does being high risk affect my care?

If you have a high-risk pregnancy, you may need more frequent prenatal appointments and will
be monitored closely by your providers. You may also be referred to a maternal-fetal medicine
(MFM) doctor. This is a physician who is specially trained to care for women who have a high-
risk pregnancy.

The exact care you and your baby need depends on your particular circumstances and on the
reasons your pregnancy is high-risk. You might see your MFM doctor just once or regularly
throughout your pregnancy. Your MFM doctor will work with your ob-gyn and other providers
to keep you and your baby healthy as your pregnancy progresses.

How does being high-risk affect my labor?

It's worth preparing yourself for the idea that the birth you have may not be the birth you'd
choose. If your pregnancy is high-risk, you won't have the option of a home birth or attending a
birth center. You'll need to give birth in a hospital where you and your baby can be monitored
closely and specialist care is available during the birth and afterward.

If you're having multiples, you're more likely to go into labor early. Preterm labor is also more
likely if you have a high-risk pregnancy for other reasons, such as having too much amniotic
fluid around the baby or having certain medical conditions.

You may also need to have your labor induced to prevent or reduce health problems for you and
your baby. Or there may be reasons why a vaginal birth isn't possible and you need to have a c-
section.

Talk to your provider about what you can expect during labor, so you can prepare yourself in the
best way possible.