Management of high risk pregnancies

Notes
  • Each pregnancy is at risk for an adverse outcome for the woman and her infant
  • Risks at pregnancy can be reduced by instituting effective maternal care before, during and after birth
  • The high risk pregnancies include the following:

_Previous stillbirth or neonatal loss

_History of > 3 consecutive spontaneous abortions

_Still birth

­_Birth weight of last / current baby <2500gm (LBW suggestive of prematurity)

­_Birth weight of last / current baby >4500gm (Large baby)

_High parity 5+ (implying short birth interval)

­_Hypertension or pre-eclampsia or eclampsia

_Previous surgery on reproductive tract

_Obstructed labor

_Caesarian section

_Multiple pregnancy

_Extreme reproductive age: Age < 15yrs or > 35yrs

_Primigravida: too young or too old

_Isoimmunization Rh (-) in current or in previous pregnancy

_Antepartum or postpartum hemorrhage

_Infection(s)

_Pelvic mass

_Postdate pregnancy

_Insulin-dependent diabetes mellitus

_Renal disease

_Cardiac disease

_Hyperemesis gravidarum (persistent vomiting past the 1st trimester and excessive vomiting at any time)

_Known “substance” abuse (including heavy drinking)

_Hydatidaform pregnancy

_Pracenta previa

_Abruptio placenta

_Polydromnios (> 2000mL of amniotic fluid)

_Oligohydromnios (< 1000mL of amniotic fluid)

_Ectopic pregnancy

_Any other disease/condition

Diagnosis
  • Not applicable
Differential
  • Not applicable
Prevention
  • Increase access to antenatal care in pregnancy (≥ 4 visits)
  • Skilled care during childbirth
  • Skilled care and support in the weeks after childbirth.
  • Establishment of emergency obstetric care to address the major causes of maternal death
  • Poverty reduction
  • Education of women and communities
  • Improvement of infrastructure
Management
  • Management of the underlying disease/condition
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