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A high risk pregnancy is one in which the life or health of the mother or fetus is
jeopardized by a disorder coincidental with or unique to pregnancy.
Risk assessment:
Biophysical -factors that originate within the mother or fetus and affect the development
or functioning of either one or both.
Examples: genetic disorders, nutritional and general health status, and medical or
obstetric-related emergencies
Psychosocial -maternal behaviors and adverse lifestyles that have a negative effect on
the health of the mother or fetus.
Ex: emotional distress and disturbed interpersonal relationships, inadequate social
support, unsafe cultural practices, substance use, abuse
Sociodemographic -arise from the mother and her family. These risks may place the
mother and fetus at risk.
Ex: lack of prenatal care, age, low income, marital status, ethnicity.
Environmental– hazards in the workplace and the woman’s general environment. May
include environmental chemicals (ie: pesticides, lead, and mercury), radiation, and
pollutants.
Spontaneous Abortions/Miscarriages
(1) Threatened– include spotting of blood but with the cervical os closed. Mild uterine
cramping may be present.
(2) Inevitable– involves a heavy amount of bleeding with an open cervical os. Tissue
may be present with the bleeding. May involve rupture of membranes and cervical
dilation. Passage of the products of conception may occur.
(3) Incomplete– Involves expulsion of the fetus with retention of the placenta.
(4) Complete– all fetal tissue is passed, the cervix is closed and there may be slight
bleeding.
(5) Missed– a pregnancy in which the fetus has died but the products of conception are
retained in utero for several weeks.
Causes:
-A late miscarriage/abortion (12-20 weeks) usually results from maternal causes, such
as advancing maternal age and parity, chronic infections, premature dilation of the
cervix and other anomalies of the reproductive tract, chronic debilitating diseases, poor
nutrition, and recreational drug use.
Diganosis: Assess pain, bleeding, LMP (to determine gestational age), pain (type,
location, duration, precipitating and palliative factors), vital signs, previous pregnancies
(incl. losses), emotional status
– HCG levels: low levels of HCG are characteristic of miscarriage (HCG should double
q48 hr in normal preg).
– Ultrasound
– Dilation and Curetage (D&C)- surgical procedure in which the cervix is dilated and a
curette is inserted to scrape the uterine walls and remove uterine contents. Used to tx
inevitable and incomplete miscarriages.
Ectopic Pregnancy- the fertilized ovum is implanted outside the uterine cavity.
– leading pregnancy-related cause of 1st trimester maternal deaths and is responsible
for 9% of all maternal deaths.
– Implants within 1st week, as it grows, baby can rupture tube and cause fullness.
S/S: abnormal vaginal bleeding, adnexal fullness and pain are classic sx. Abdominal
pain is usually the primary presenting sx at approx 5-6 weeks of gestataion.
– The tenderness can progress from a dull pain to a colicky pain when the tube
stretches, to sharp stabbing pain.
DES Daughter- have reproductive issues d/t mother taking med for preterm labor.
Treatment:
– Vaginal exam should be performed only once, and then great caution.
– Removal of the ectopic preg. is possible when the pregnancy is <2cm in length.
Anemia
1. Hemoglobin = 11 or less (normal non-preg 37-47%, pregnant = >33%)
2. Have s/s if Hgb <6-7
3. Results in decrease of O2 carrying capacity of the blood- heart tries to compensate
by increasing the cardiac output.
4. Anemia that occurs with any other complication (ie: preeclampsia) may result in CHF
5. Increased risk of puerperal complications.
6. Iron deficiency anemia= most common
Treatment:
Folate Deficiency
1. Poor diet and increased alcohol intake may contribute
2. Malabsorption may play a part in development of anemia
3. S/S: Pallor, fatigue, lethargy
4. More common in multiple gestation
5. Recommended intake during pregnancy= 400 mcg
6. Should consume legumes, green/leafy vegetables.
Sickle Cell
1. Stress of pregnancy can active it- causing sickle cell crisis
2. Risk for UTI’s, iron deficiency, and hematuria.
3. Fetal complications= SGA, IUGR, Skeletal changes
Thalassemia
1. Hemoglobin problem- premature RBC death
2. 2 types: Major and minor
1. Minor= trait- minor persistent anemia during pregnancy but RBC’s normal or
elevated
2. Major= disease
Thromboembolic Disease
1. SVT’s and DVT’s
2. Deep Vein Thrombosis= more prevalent in pregnancy
3. s/s: unilateral leg pain, calf tenderness, swelling
4. Fibrogenin increases-> blood is hyperclottable
5. Venous stasis- hard for blood to come up body
6. Tx: Heparin-> doesn’t cross placenta.
1. Can use subq heparin at home
2. No oral contraceptives- increases risk of DVT’s
3. Okay to breastfeed- avoid cracked nipples
1. SVT= more common in postpartum
2. s/s: warmth, tenderness, enlarged hardened vein over site.
Substance Abuse
1. Marijuana and cocaine most commonly used
2. Cocaine= causes severe muscle contractions, abruption of placenta
3. Methadone (heroin)= every effort is made to get mom on methodone. More
controlled source
4. Alcohol= no safe limit- fetal alcohol syndrome-
– mental, physical and behavioral effects.
Cardiac Disease
Risk greatest in 2nd trimester and immediately after delivery
All extra circulating volume that was in placenta, etc has to go back into mom’s
circulation= massive overload
Class III: Symptomatic with marked limitation of activity (ie: can’t go up 2 stairs
without getting winded)
Class IV: Symptoms at rest (Can’t sit in chair without getting winded)
Classes I and II = will do close monitoring during pregnancy
Classes III and IV= Major difficulties in pregnancy- should be in specialized hospital.
Tx: Rest, avoid infections, low salt diet, avoid anemia, O2, avoid constipation, monitor
for thrombophlebitis, decrease stress