high risk 1

• 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.
• Categories of Risk Factors

  • Biophysical Risk
  • Psychosocial Risk
  • Socio-demographic Risk
  • Environmental Factors
• Biophysical Risk


  • Factors that originate within mother and fetus and affect the development or functioning of either one or both
  • Includes genetic disorders, nutritional & general health status, medical or obstetrical illness like poorly controlled diabetes mellitus or hypertensive disorders
• Psychosocial Risk


  • Maternal behaviors and adverse life style, such as disturbed interpersonal relationships, emotional distress, inadequate social support, unsafe cultural practices, substance abuse
• Socio-demographic Risk


  • Arises from the mother and her family, such as low income, lack of prenatal care, age (adolescent or older mother), parity, marital status, ethnicity
• Environmental Risk


  • Hazards in the workplace such as exposures to chemicals, anesthetic gases, radiation, infection, drugs, environmental pollutants
• Risk Assessment


  After information gathering at a first prenatal visit, findings are analyzed to determine whether a pregnancy is apt to continue with a good outcome, or there is likely to be some risk that it will end before term, or with an unfavorable fetal or maternal outcome
• Components of Health Assessments for a First Pregnancy Visit

  • Health History
  • Physical Examination
  • Laboratory Assessment
• Health History


  Includes demographic data, chief concern, family & social profile, past medical history, gynecologic history, obstetric history, review of system
• Assessments that might categorize a pregnancy as at risk

  • Demographic factors
  • Chief Complaint
  • Past illness history
  • Obstetric history
  • Current obstetric status
  • Psychosocial factors
• Psychological Considerations for High Risk Pregnancy


  • Increased sense vulnerability, stress related to diagnoses, ambivalence regarding the pregnancy, inability to accomplish the task of parenthood, fearful for well-being of the mother
• Risk assessment should be updated at each prenatal visit because events can cause a pregnancy first rated as low risk to change to high risk.
• Components of Physical Examination

  • Baseline Data (Height/Weight and Vital Sign Measurement)
  • System Assessment
  • Pelvic Examination
• Baseline Data


  Taken at first prenatal visit to establish a baseline for future comparison, including vital signs like blood pressure, respiratory rate, and pulse rate
• Physical Examination Components


  • Baseline Data
  • System Assessment
  • Pelvic Examination
• Baseline Data


  Baseline Height/Weight and Vital Sign Measurement
• Baseline height/weight and vital signs are taken at the first prenatal visit to establish a baseline for future comparison
• A sudden increase in blood pressure, the same as a sudden weight gain


  Is a danger sign of hypertension of pregnancy
• A sudden increase in pulse or respirations


  Can suggest bleeding
• System Assessment Components


  • General Appearance and Mental Status
  • Nose
  • Ears
  • Sinuses
  • Mouth, Teeth, & Throat
  • Neck
  • Head and Scalp
  • Eyes
  • Lymph Nodes
  • Breasts
  • Heart
  • Lungs
  • Back
  • Rectum
  • Extremities & Skin
• Pelvic Assessment


  Measurement of Fundal Height and Fetal Heart Sounds
• If a woman is past 12 weeks of a pregnancy, palpate the fundus location, measure the fundal height (from the notch above the symphysis pubis to the superior aspect of the uterine fundus)
• Fetal heart sounds (120 to 160 beats per minute) can be heard at 10 to 12 weeks if a Doppler technique is used, but not until 18 to 20 weeks if a regular stethoscope is used
• Palpate for fetal outline and position after the 28th week to further estimate fetal size and growth
• Pelvic Examination


  Reveals information on the health of both internal and external reproductive organs
• Equipment required for Pelvic Examination

  • Speculum
  • Spatula for cervical scraping
  • Clean examining glove
  • Lubricant
  • Glass slide or liquid collection device for Pap smear
  • Culture tube
  • Two or three sterile cotton-tipped applicators or cytobrushes for obtaining cervical cultures
  • Good examining light
  • Stool at correct sitting height
• External Genitalia Examination


  Signs of inflammation, irritation, or infection, such as redness, ulcerations, or vaginal discharge, are noted
• Skene glands and Bartholin glands


  If a discharge is produced from any of these gland ducts, a culture is obtained. Infection here could be caused by something as simple as streptococci; often it is gonorrhea.
• Vaginal muscle wall support

  Rectocele (a forward pouching of the rectum into the posterior vaginal wall because of loss of posterior vaginal muscular support) or a cystocele (a pouching of the bladder into the anterior vaginal wall, caused by loss of anterior vaginal muscular support), are also evaluated
• Cervix Examination


  Color & any lesions, ulcerations, discharge, or otherwise abnormal appearance are documented
• In a nulligravida the cervical os is round and small
• In a woman who has had a previous pregnancy with a vaginal birth, the cervical os has much more of a slitlike appearance
• If a woman had a cervical tear during a previous birth, the cervical os may appear as a transverse crease the width of the cervix or a typical starlike
• If a cervical infection is present, a mucus discharge may be present, the epithelium of the cervical canal often enlarges and spreads onto the area surrounding the os, giving the cervix a reddened appearance (erosion)
• Trichomoniasis


  A protozoal infection, generally causes signs of redness; a profuse, whitish, bubbly discharge; and petechial spots on the vaginal walls
• Candidal (Monilia)


  Typically presents with thick, white vaginal patches that may bleed if scraped away
• Gonorrhea infection


  Presents with a thick, greenish-yellow discharge and extreme inflammation
• Chlamydia infection


  Shows few symptoms except slight cervical redness
• Carcinoma of the cervix


  Appears as an irregular, granular growth at the os
• Cervical polyps


  Red, soft, pedunculated benign protrusions occasionally seen at the os