Chapter 1

• Contributing Factors for High Risk Pregnancy

  • Socioeconomic Factors
  • Demographic Factors
  • Previous Obstetric Problems
  • Maternal Medical History/Status
• Socioeconomic Factors

  • Overcrowding
  • Poor standards of housing and hygiene
  • Poor nutrition
  • Poverty and low educational status
• Parental Occupation


  Occupation of the father, as a reflection of socioeconomic status, is related to profound differences in the incidence of prematurity and infant mortality
• Social Environment


  The summation of numerous factors, including the family's standards of health and hygiene, housing and financial status, emotional and social support
• Psychological High-Risk Factors


  Maladaptations may increase anxiety, and it has been suggested increased anxiety can cause physical complications during pregnancy, including preterm labour
• Demographic Factors


  • Maternal Age
  • Maternal Education
  • Maternal Height
  • Maternal Weight and Weight Gain
• Maternal Age


  The optimal age for childbearing is between 20 and 30 years, with a steadily increasing risk of perinatal mortality when the woman is over 30 years of age
• Maternal Education


  As the length of the mothers education increases, perinatal morbidity and mortality rates drop significantly
• Maternal Height


  Short stature (less than 5 ft) has been associated with increased perinatal morbidity and mortality
• Maternal Weight and Weight Gain


  Women who are underweight or overweight for height and age at the beginning of pregnancy are at risk for poor perinatal outcome
• Previous Obstetric Problems

  • History of Infertility
  • Previous Ectopic Pregnancy and Spontaneous Abortion
  • Previous Stillbirth or Neonatal Death
  • Uterine/Cervical Abnormality
  • Previous Premature Labour
  • Previous Macrocosmic Infant
  • Grandmultiparity
• History of Infertility


  Conceptions following medical or surgical treatment of infertility carry a considerable high-risk factor
• Previous Ectopic Pregnancy and Spontaneous Abortion


  The incidence of infertility in patients who have had an ectopic pregnancy is high, as is the chance of a repeat ectopic conception. In women who have had two or more spontaneous abortion, the risk of a repeat abortion is significantly increased
• Uterine/Cervical Abnormality


  Abnormalities of the uterus/ cervix such as a bicornuate uterus, uterine septum, and incompetent cervix are frequently associated with repeated spontaneous abortions and premature labour
• Incompetent Cervix


  Cervical incompetence may be congenital or acquired. The most common congenital cause is a defect in the embryological development of Mullerian ducts. Ehlers-Danlos syndrome or Marfan syndrome, due to the deficiency in collagen, the cervix is not able to perform adequately, leading to insufficiency
• Cervical Cerclage


  Transvaginal and transabdominal cervical cerclage. The two types of this commonly used vaginal procedure include McDonald and modified Shirodkar
• Previous Premature Labour


  A woman who has had a previous premature labor has a significantly higher chance of delivering prematurely with a subsequent pregnancy
• Previous Macrocosmic Infant


  A woman who has previously had, or is suspected of carrying, a large infant is at risk for having or developing diabetes during pregnancy, with all its concomitant problems
• Grandmultiparity


  Increasing parity increases the risk of pregnancy wastage both in terms of higher mortality rates and an increased risk of neurologic anomaly
• Maternal Medical History/Status


  • Sexually Transmitted Infections & Pregnancy
• Sexually Transmitted Infections


  Having an STI during pregnancy can cause premature labor, birth defects, blindness, deafness, and bone deformities
• Types of Sexually Transmitted Infections

  • Candidiasis
  • Trichomoniasis
  • Chlamydia
  • Syphilis
  • Herpes infection (Herpes Simplex)
  • Gonorrhea
  • HPV- Human Papilloma Virus
  • HIV/AIDS. Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome
  • Pubic lice
• Candidiasis


  Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida. Increase incidence during pregnancy due to lower vaginal acidity. Symptoms include thick, cream cheese-like vaginal discharge, extreme pruritus, redness & irritation of vagina. Treated with local application of antifungal cream
• Premature labor (labor before 37 weeks of pregnancy) is the number one cause of infant death and can lead to long-term developmental and health problems in children
• When left untreated, STDs and STIs can pass from the mother to her baby, causing serious problems
• Birth defects


  • Blindness
  • Deafness
  • Bone deformities
• Candidiasis


  A fungal infection caused by a yeast (a type of fungus) called Candida
• Some species of Candida can cause infection in people; the most common is Candida albicans
• Vulvovaginal candidiasis (VVC)


  Approximately 30-50% of women are affected by it at least once during their lifetime
• Symptoms of yeast infection

  • Thick, cream cheese-like vaginal discharge
  • Extreme pruritus
  • Redness & irritation of vagina
• High risk groups for yeast infection

  • Women being treated with antibiotics
  • Gestational diabetis mellitus
  • Women with HIV
• Treatment for yeast infection

  Local application of antifungal cream: Miconazole, Fluconazole
• Trichomoniasis is caused by a single cell protozoan
• Symptoms of trichomoniasis


  • Itching, burning, redness or soreness of the genitals
  • Discomfort when peeing
  • Clear, white, yellowish, or greenish vaginal discharge (i.e., thin discharge or increased volume) with a fishy smell
  • Yellow- gray frothy, odorous vaginal discharge
• Possible complications of trichomoniasis in pregnancy

  • Pre term labor
  • PROM- Premature rapture of membrane
  • Post C/S infection
• Bacterial vaginosis


  A local infection of the vagina, common cause is Gardnerella organism
• Gardnerella vaginalis is a natural part of the environment in your vagina. You can get BV if too much Gardnerella grows
• Causes of BV are unknown, but people with more sex partners and multiple sex partners are more at risk for getting BV
• Vaginitis test - wet mount

  You lie on your back on the exam table, the provider gently inserts an instrument (speculum) into the vagina to hold it open and view inside, a sterile, moist cotton swab is gently inserted into the vagina to take a sample of discharge, the swab and speculum are removed
• Possible complications of bacterial vaginosis

  • Amniotic Fluid Infection
  • Preterm Labor
  • PROM