HIGH RISK PREGNANCY

HIGH RISK PREGNANCY

• RISK FACTORS
• Identifying risk of pregnancy is an
impt part of pre natal care. When
risk factors are identified early
during pregnancy preventive
measures can be instituted and
early treatment can be provided for
disease conditions to ensure that
successful pregnancy outcome and
prevent complications
Pregnancy risk factors includes
but not limited to the following:
• Age: younger than 18 yrs old or older than 35
• Weight: underweight or overweight for height
• Nutritional status: anemia and nutritional deficiencies
• Income: having limited financial resources
• Multiparity: previously given birth more than four times
• Obstetrical Hx: pre term bith, abortion, stillbirth, birth of
LGA infant, post term, difficult deliveries
• Family Hx of genetic diseases or previous baby with a birth
defects
• Substance user: cigarettes, alcohol, drugs
• Pre existing medical conditions including DM, HPN, and
heart disease
• Infertility medications or treatments: more likely to result in
multiple births
• External risk factors: high temperatures, radiation
exposure,and high altitudes
 BLEEDING DISORDERS OF
PREGNANCY
• HEMORRHAGE rapid loss of more
than 1 % of body weight in
blood.Rapid blood loss results in:
• Inadequate tissue perfusion
• Deprivation of glucose and oxygen in
the tissue
• Build up of waste products
• HYPOVOLEMIC SHOCK occurs
bleeding result in blood loss
amounting to 1.5 to 2 liters
•
 PERINATAL HEMORRHAGE

• Is hemorrhage that occurs during pregnancy, labor and delivery

• Kinds:
• ANTEPARTUM HEMORRHAGE: refers to hemorrhage that occurs
anytime during pregnancy. early ante partum hemorrhage
(before 20 wks gestation) msy be caused by abortion, ectopic
pregnancy, and molar pregnancy while late ante partum
hemorrhage (after 20 wks gestation)may result from placental
abruption and placenta previa
• INTRAPARTUM HEMORRHAGE occurs during labor and is most
commonly due to:
• Placental abruption
• Uterine rupture
• Uterine inversion
• Abnormal adhesions of the placenta
• Cs complications
• POSTPARTUM HEMORRHAGE blood loss greater than 500 ml. in
vaginal delivery or 1000 ml in CS
• Early postpartum hemorrhage occurs during the first 24 hours
after delivery.the most common cause is uterine atony and
• LATEPOSPARTUM HEMORRHAGE occurs
during the first 24 hours after delivery
and is most often due to retained
placental fragment and subinvolution
of the uterus.
• DIFFERENT BLEEDING DISORDER
• FIRST TRIMESTER BLEEDING abortion
and ectopic pregnancy
• SECOND TRIMESTER BLEEDING
hydatidiform mole and incompetent
cervix
• THIRD TRIMESTER BLEEDING placenta
previa and abruptio placenta
 ABORTION
• Is the most common bleeding disorder of early
pregnancy. It’s the termination of pregnancy before
viability, that’s before 20 wks gestation from LMP or
before the fetus weighs 500 grms . Spontaneous
abortion occurs in 15-20% of recognized pregnancy.
• Early abortion is the termination of pregnancy before
12 wks
• Late abortion occurs between 12 to 20 wks. A
distinction is made between early and late abortion
because more difficulties are encountered in late
abortions. After 12 wks of pregnancy, the definitive
placenta with a more organized and larger blood
supply has begun to form, so bleeding is more likely.
Fetal bones have also begun to form, and the long
bones of the limbs may perforate the uterus during
evacuation.In addition, cervical dilatation to enable
the fetus to pass through is more difficult in
pregnancies more then 12 wks.
• OCCULT PREGNANCY refers to those zygotes
that were aborted before pregnancy is
diagnosed or recognized
• CLINICAL PREGNANCY is pregnancies that were
diagnosed. Of 1000 ovulatory cycles only 673
will result in clinical pregnancy. Approx. 15%
of all clinically recognized pregnancies end in
spontaneous abortion.
• ABORTION is the spontaneous or induced loss of
an early pregnancy. The period of pregnancy
prior to fetal viability outside of the uterus is
considered early pregnancy. Most consider
early pregnancy to end at 20-24 weeks
gestation. The term miscarriage is used often
in the lay language and refers to spontaneous
abortion.
 TYPES OF ABORTION
• ELECTIVE OR THERAPEUTIC
ABORTION the deliberate
termination of pregnancy
• Elective abortion are those initiated
by personal choice
• Therapeutic abortion are those
recommended by the health care
provider to protect the mother’s
physical or mental health.
• SPONTANEOUS ABORTION the loss of
the fetus during pregnancy due to
 DEFINITION OF TERMS
• BLIGHTED OVUM a small macerated fetus,
sometimes there is no fetus, surrounded by a
fluid inside an open sac
• CORNEOUS MOLE a zygote that is sorrounded
by a capsule of clotted blood
• FETUS COMPRESSUS a fetus compressed upon
itself and desicaated with dried amniotic fluid
• FETUS PAPYRACEOUS a fetus that is so dry that
resembles a parchment
• LITHOPEDION a calcified fetus
• IMMATURE INFANT refers to infant having a birth
weight between 500 to 1000 grams
• FULL TERM INFANT refers to an infant born
between 38 to 42 weeks
 CAUSES OF SPONTANEOUS
ABORTION
• FETAL CAUSES the most common cause,
about 80-90% of early spontaneous
abortion is abnormal development of the
zygote, embryo or fetus. These
abnormalities are so severe that they are
incompatible with life.
• 1. Developmental anomalies in more than
60% of cases
• 2. Chromosomal abnormalities trisomies are
the most common chromosomal
abnormalities with trisonomy 16 as the
most common trisonomy found. The most
common single chromosomal anomaly is
45, X karyotype.
 HIGH RISK PREGNANCY
• RISK FACTORS
• Identifying potential risk of pregnancy is
an impt. Part of pre natal care.when
risk factors are identify early during
pregnancy timely preventive
measures can be instituted and early
treatment can be provided for disease
conditions to ensure successful
pregnancy outcome and prevent
further complications.
• It includes but not limited to the
following:
• Age factor: younger than 18 yrs old but
 HIGH RISK PREGNANCY
• RISK FACTORS
• IDENTIFYING POTENTIAL RISK OF
PREGNANCY IS AN IMPT. PART OF
PRE NATAL CARE
• WHEN RISK FACTORS ARE KNOWN
EARLY IN PREGNANCY, TIMELY
PREVENTIVE MEASURES CAN BE
INSTITUTED AND EARLY
TREATMENT CAN BE PROVIDED FOR
DISEASE CONDITIONS TO ENSURE
SUCCESSFUL PREGNANCY
Pregnancy risk factors includes
but not limited to the following
• Age younger than 18 yrs old but older than 35
• Weight :underweight or overweight for height
• Nutritional Status: anemia and nutritional deficiencies
• Income: having limited financial resources
• Multiparity: previouslygiven birth more than four times
• Obstetrical Hx: preterm birth, abortion, stillbirth,birth of LGA
infant,post term,difficult deliveries
• Family Hx of genetic diseases or previous baby with a birth
defects
• Substance user: cigarettes, alcohol, drugs
• Pre existing medical conditions including diabetes, high
blood pressure and heart disease
• Infertility medications or treatments: more likely to result in
multiple births
• External risk factors: high temp. ,radiation exposure and
high altitudes