HUGH RISK FACTOR PREGNANCY

• High-risk pregnancy


  A concurrent disorder, pregnancy related complication, or external factor jeopardizes the health of the mother, the fetus, or both
• High-risk prenatal client


  • A woman who enters pregnancy in good health, but then develops a complication of pregnancy that causes it to become high-risk
  • A woman who enters pregnancy with a chronic illness that, when superimposed on the pregnancy, makes it high-risk
  • A woman who enters pregnancy with a combination of particular circumstances - poverty, lack of support people, poor coping mechanisms, genetic inheritance, or past history of pregnancy complications
• Assessment for risk factors

  • Biophysical factors
  • Psychosocial factors
  • Sociodemographic factors
  • Environmental factors
• Biophysical factors


  • Originate from the mother or fetus & impact the development or function of the mother or fetus
  • Include genetic, nutritional, medical, and obstetric issues
• Preexisting medical conditions


  • Hypertensive disorder
  • Renal disease
  • Pulmonary or Cardiac disease
  • Autoimmune disease
  • Type 1 diabetes
• Pregnancy-related conditions


  • Pregnancy-related hypertension
  • Decreased fetal movement
  • Hydramnios/Polyhydramnios
  • Oligohydramnios
  • Placental problems
• Fetal conditions


  • Intrauterine Growth Restriction (IUGR)
  • Multiple gestation
  • Post-term pregnancy
  • Previous unexplained fetal demise
  • Rh Isoimmunization
  • Fetal anomalies
• Psychosocial factors


  • Maternal behaviors or lifestyles that have a negative effect on the mother or fetus
• Sociodemographic factors


  • Variables that pertain to the woman and her family and place the mother and the fetus at increased risk
• Environmental factors


  • Hazards in the workplace or the general environment that impact pregnancy outcomes
• Environmental factors


  • Occupation involving handling of toxic substances (Radiation and anesthesia gases)
  • Environmental contaminants at home
  • Poor housing conditions
• 15 years old and below


  Young adolescents are at risk of having adverse health outcomes since their reproductive system is not yet fully matured
• Risks for young adolescents

  • PIH
  • IDA
  • Pre-term labor
  • CPD
  • Conflicting developmental crisis
  • Lack of knowledge about infant care
• Above 35 years old


  Old primis are associated with abnormalities
• Risks for women above 35

  • Hypertension of pregnancy
  • Pre-term/Post-term birth
  • CS birth
  • Post Partum hemorrhage
  • Chromosomal abnormalities
• Mother is underweight (less than 45.5 kgs or 100 lbs)


  BMI <18.5
• Maternal implications of underweight

  • poor nutrition
  • CPD
  • prolonged labor
• Fetal implications of underweight

  • IUGR
  • Hypoxia associated with difficult labor and birth
• Mother is overweight (more than 91 kgs or 200lbs)


  BMI >30
• Maternal implications of overweight

  • Increased risk of developing hypertension
  • CPD
  • DM
• Fetal implications of overweight


  • Increase risk of macrosomia
• Mother has anemia (Hgb less than 11g/l)


  The iron needs of pregnancy are obtained from maternal iron stores, diet, and supplementation. With anemia occurring in pregnancy, the most common cause is iron deficiency.
• Maternal implications of anemia


  • IDA
  • low energy levels due to decreased oxygen carrying capacity of the RBC
• Fetal implications of anemia


  • fetal death
  • prematurity
  • LBW
• Poor nutritional status


  Maternal implications include: inadequate nutrition, increase risk of anemia, increase risk of pre-eclampsia
• Fetal implications of poor nutritional status


  • fetal malnutrition
  • prematurity
  • small for gestational age
• Pre-existing medical conditions


  • DM
  • HPN
  • Thyroid disorder
  • Cardiac Disease
• Maternal implications of DM


  • increase risk of preeclampsia
  • episodes of hypoglycemia
  • increase risk for CS
• Fetal implications of DM


  • LBW
  • macrosomia
  • neonatal hypoglycemia
  • increase risk of congenital anomalies
  • increase risk of respiratory distress syndrome
• Maternal implications of HPN


  • vasospasm
  • increase risk of CNS irritability which results to convulsion
  • increase risk of developing CVA
  • increase risk of renal damage
• Fetal implications of HPN


  • decreased placental perfusion which leads to LBW
  • preterm birth
• Maternal implications of thyroid disorder


  • increased infertility
• Fetal implications of thyroid disorder


  • increased risk for spontaneous abortion
• Maternal implications of cardiac disease


  • cardiac decompensation
• Fetal implications of cardiac disease


  • increased maternal death rate
  • increase risk of fetal demise
• Substance abuse


  • Alcohol
  • Smoking
  • Caffeine
  • Cocaine and other illicit drugs
  • Perinatal addiction
• Alcohol


  • 10g/day (1 drink) increases the risk of miscarriage and fetal death
  • 17g/day (2 drinks) increases the risk of preterm birth
  • 12-30g/day (2-3 drinks) suppresses fetal breathing movements
  • 20g/day (2- 2.5 drinks) reduces fetal growth and birth weight
  • 60g/day (7+ drinks) increases the incidence of congenital anomalies
  • 90g/day (10+ drinks) may cause fetal alcohol syndrome (FAS)
• Fetal Alcohol Syndrome


  Characterized by dysmorphic features, microcephaly, learning disabilities, low birth weight, stunted growth, neurodevelopmental delay, hearing, language and speech disorders, behavioral problems, hyperactivity, attention deficits and sometimes cardiac, kidney or limb abnormalities

  
• Smoking


  • Maternal implications include: miscarriage, premature delivery, ectopic pregnancy, placental problems
  • Fetal implications include: LBW, stillbirth and birth defects
  • Nicotine causes vasoconstriction, decreased blood flow to the placenta, decreased oxygen to fetus (Hypoxia), leading to low birth weight
• Caffeine


  • Above 150 mg/day may increase risk of IUGR and spontaneous abortion
  • Above 200mg/day intake may decrease birth weight
  • Above 300mg/day intake increased risk of fetal death
  • Above 500mg/day can cause "caffeinism", which presents as an anxiety disorder