How to Identify, Diagnose or Screen High Risk Pregnancy?

Definition of High Risk Pregnancy or Mother:

High risk pregnancy is defined as one which is complicated by factor or factors that adversely affects the pregnancy outcome- maternal or prenatal or both.

High Risk Pregnancy
Fig: High Risk Pregnancy

Danger Signs of Pregnancy:

  1. Swelling of the feet,
  2. Convulsion,
  3. Blurring of vision,
  4. Per-vaginal bleeding (even in small amount),
  5. Per-vaginal discharge.

How to Identify High Risk Pregnancy?

High risk pregnancies or WHO (1978) criteria of high risk cases:

1. During pregnancy:

  • Elderly primi (> 30 years of age),
  • Short stature primi (< 140 cm),
  • Threatened abortion & antepartum haemorrhage (ApH),
  • Malpresentation,
  • Pre-eclampsia & eclampsia,
  • Anaemia,
  • Elderly grand multiparas,
  • Twins & polyhydramnios,
  • Previous history of still birth, IUD, IUGR, manual removal of placenta,
  • Prolong pregnancy,
  • History of previous caesarean section & instrumental delivery,
  • Pregnancy associated with medical disease.

2. During labour:

  • Pre-mature rupture of membranes (PROM),
  • Prolong labour,
  • Hand, feet or cord prolapse,
  • Placenta retained more than half an hour,
  • Post-partum haemorrhage,
  • Puerperal fever & sepsis.

How to Diagnose or Screen the Cases of High Risk Pregnancy?

The cases are assessed at the initial antenatal examination, preferably in the first trimester of pregnancy.

A. History taking:

1. Maternal age: Pregnancy < 17 years &>35 years.

2. Family history:

  • Socio-economic condition: Poor socio-economic status has a high incidence of anaemia.
  • IUG & preterm labour etc.
  • Women who undertake long road journeys have a higher incidence of recurrent abortion or preterm labour.
  • Family history of diabetes mellitus, hypertension, multiple pregnancy (maternal side), congenital anomalies.

3. Obstetric History:

  • Two or more previous spontaneous / induced abortion.
  • Previous still birth, neonatal death or birth of babies with congenital anomaly.
  • Previous preterm or small for date or big baby (> 3kg) delivery.
  • Grand multiparity.
  • Previous caesarean section or hysterototomy.
  • Pre-eclampsia or eclampsia.
  • Third stage abnormalities: This has a particular tendency to recur.
  • Previous infant with Rh-isoimmunisation or AB0 incompatibility.

4. History of medical diseases:

5. Past Surgical History:

  • Myomectomy,
  • Repair of vesico-vaginal fistula (VVF),
  • Repair of complete perineal tear,
  • Repair of stress incontinence.

B. Clinical examination:

1. General examination:

  • Height: < 150cm,
  • Weight: Overweight or underweight both are risk factor,
  • High blood pressure,
  • Anaemia,
  • Cerdiac or pulmonery dlseases.

2. Per-abdominal examination:

  • Genital prolapse
  • Laceration or dilatation of the cervix.
  • Associated tumor.

3. Follow up:

After initial visit, the high risk cases should be reassessed at each antenatal visit to detect any abnormality that might have arisen later; such as –

  • Pre-eclampsia,
  • Anaemia,
  • Rh-isoimmunisation,
  • High fever,
  • Pyelonephritis,
  • Haemorrhage or P/V bleeding,
  • Diabetes mellitus,
  • Large uterus,
  • Lack of uterine growth,
  • Post-maturity,
  • Abnormal presentation,
  • Twin pregnancy,
  • History of teratogenic drug intake.

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