High Risk Pregnancy

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HIGH RISK PREGNANCY
Is one in which the mother or fetus has a significant increased chance of harm, damage, injury or disability (morbidity), & loss of life or death (mortality) RISK FACTORS
A. DEMOGRAPHIC FACTORS
← Age – under 16 or over 65 years old. Optimal childbearing is between 20-30 years old ← Weight – overweight or underweight before pregnancy ← Height – less than 5 feet
B. SOCIOECONOMIC STATUS
• Inadequate finances
• Overcrowding, poor standards of housing, poor hygiene • Nutritional deprivation
• Severe social problems
• Unplanned & unprepared pregnancy, especially among adolescents C. OBSTETRIC HISTORY
• History of infertility or multiple gestation
• Grandmultiparity
• Previous abortion or ectopic pregnancy
• Previous loses: fetal death, stillbirth, neonatal or perinatal deaths • Previous operative OB: CS, midforceps delivery
• Previous uterine or cervical abnormality
• Previous abnormal labor
• Previous high risk infant
D. CURRENT OB STATUS
← Late or no prenatal
← Maternal anemia
← Rh sensitization
← Antepartal bleeding
← PIH
← Multiple gestation
← Premature/post mature labor
← Polyhydramnios
← PROM
← Fetus inappropriately large or small; abnormal presentation E. MATERNAL MEDICAL HISTORY/STATUS
← Cardiac or pulmonary disease
← Metabolic disease: DM, thyroid disease
← Endocrine disorders: pituitary, adrenal
← Chronic renal disease: repeated UTI, bacteriurea
← Chronic hypertension
← Major congenital anomalies of the reproductive tract ← Hemoglobinopathies
← Seizure disorders
← Malignancy
← Major emotional disorders/mental retardation
F. HABITS/HABITUATION
← Smoking during pregnancy
← Regular alcohol intake
← Drug use/abuse

DIAGNOSTIC TESTS IN HIGH RISK PREGNANCY
Ultrasonography
← A non-invasive diagnostic procedure utilizing high-frequency sound waves to detect intrabody structures Types of Ultrasound
← Transabdominal Ultrasound
← Transvaginal Ultrasound
TRANSABDOMINAL ULTRASOUND
← Ask the client to FILL BLADDER
TRANSVAGINAL ULTRASOUND
← Ask client to void

Major uses of UTZ during pregnancy
FIRST TRIMESTER
❖ Confirm the pregnancy
❖ Confirm viability
❖ Determine gestational age
❖ Rule out ectopic pregnancy
❖ Detect multiple gestation
❖ Detect maternal abnormalities
Second trimester
❖ Confirmed dates
❖ Confirm viability
❖ Detect polyhydramnios / oligohydramnios

❖ Detect congenital anomalies
❖ Confirm placenta placement
❖ Use for visualization during amniocentesis
Third trimester
❖ Confirm gestational age
❖ Confirm viability
❖ Detect macrosomia
❖ Detect congenital anomalies
❖ Detect fetal position
❖ Detect placental anomalies placental maturity
Non Stress Test
← Used to assess fetal status using an electronic fetal monitor ← Based on the knowledge
← Well-oxygenated fetus has adequate oxygenation
← Intact central nervous system
← Unsatisfactory test – the data cannot be interpreted or there was inadequate fetal activity Clinical mgt:
← If the NST is reactive in less than 30 mins– test is concluded & rescheduled as indicated by the high risk condition that is present ← If it is non-reactive – the test is extended for 30 mins until results are reactive, & then the test is rescheduled as indicated ← It is estimated that 80% - 90% of non reactive NSTs are due to fetal sleep states ← If the FHR remains nonreactive for longer than 30 mins, the test is repeated after the woman eats or the fetus is stimulated via acoustic stimulation, foot massage or palpation. ← If a reactive test is not obtained within 40 mins, additional testing (such as UTZ) or immediate birth is considered OCT/CST

← This test is used to evaluate the ability of...
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