High-Risk Pregnancy Factors & Categories

High-Risk Prenatal Client, Maternal Risk Factors, and Categories

• A high-risk prenatal client has a concurrent disorder, pregnancy-related complication, or external factor jeopardizing the health of the pregnant person, the fetus, or both.
• High-risk status extends through the puerperium (30 days after birth) because subinvolution and puerperal infection are important considerations during this period.
• Four divisions of maternal risk in pregnancy and childbirth encompass pre-existing risks, risks emerging during pregnancy, labor and delivery risks, and postpartum risks.
• Categories of high-risk pregnancies include biophysical, psychosocial, and sociodemographic factors.

Biophysical Factors

• Genetic considerations involve potential interference with normal fetal or neonatal development, possibly resulting in congenital anomalies or difficulties for the mother
• Examples include multiple pregnancies, large fetal size, and transmissible inherited disorders like Down syndrome.
• Nutritional status can influence the mother and baby.
• Conditions like young age, multiple pregnancies in a short time frame, inadequate dietary intake, excessive weight gain, low hematocrit, and substance use impact nutritional status
• Various medical and obstetric disorders affect pregnancy risk, including preterm labor linked to young or old maternal age, low socioeconomic status, low maternal weight, poor nutrition, and previous preterm births.
• Smoking, drug/alcohol use, pneumonia, multiple gestations, anemia, and abnormal fetal presentation contribute to risk.
• Multiple gestations, poor nutrition, preeclampsia, drug/alcohol abuse, fetal infections, and chronic hypertension also pose risks.

Psychosocial & Sociodemographic Factors

• Psychosocial factors like smoking can lead to low birth weight infants, higher mortality rates, miscarriages, and PROM. Gradual reduction is advised over immediate cessation.
• High caffeine intake is linked to slight decreases in birth weight;limit of 2 cups is generally advised; avoid abruptly stopping due to potential tremors and headaches.
• Alcohol consumption can cause fetal alcohol syndrome, learning disabilities, and hyperactivity.
• Psychologic status factors include intraphysical disturbances, addictive lifestyles, unsafe cultural practices, and situational crises.
• Sociodemographic factors like low income, poor health, and lack of prenatal care increase medical complications during pregnancy.
• Women in metropolitan areas tend to have more prenatal visits compared to those in rural areas.
• Adolescent pregnancies and mature mothers pregnancy's each have different potential complications.

Antepartum Testing and Biophysical Assessment

• Antepartum testing includes biophysical assessment and biochemical assessment.
• Daily Fetal Movement Count (DFMC) or "kick counts" monitor pregnancies with complications affecting fetal oxygenation, typically after 28 weeks gestation when fetus is big enough.
• Mothers lie in the left recumbent position after a meal and record fetal movements.
• The goal is to count 10 movements, and the time should be recorded. If 10 movements are not felt in one hour, the mother should walk around and try again.
• A count of fewer than three fetal movements within one hour warrants evaluation by a healthcare provider.
• A Non-Stress Test (NST) is a painless procedure to evaluate a baby's condition by monitoring the heartbeat while the baby is resting and moving.
• If the baby is moving during the test, the heart rate should increase
• NST results are interpreted as reactive (2+ accelerations of 15+ beats/min lasting 15+ seconds in 20 min) or non-reactive (doesn't meet reactive criteria); unsatisfactory results require repeat NST or CST.

Contraction Stress Test & Ultrasonography

• A Contraction Stress Test (CST) involves administering oxytocin or nipple massage to induce labor contractions and assess fetal response.
• It is important to make the patient NPO for 4-8 hours before and that they empty their bladder. If they smoke they must stop 2 hours before.
• A negative CST result indicates the fetus should tolerate labor, while a positive result suggests that the fetus may be at increased risk and require additional testing.
• In ultrasonography, fetal activity, gestational age, growth, anatomy, and wellbeing can all be assessed.
• Ultrasounds are performed either abdominally, or transvaginally; these serve their own unique purposes in different trimesters.

Anemia Types and Iron Deficiency

• Assess soft tissues with Magnetic Resonance Imaging (MRI); costly with few uses.
• True anemia is defined by hemoglobin concentrations below 11g/dL (hematocrit <33%) in the 1st and 3rd trimesters, and below 10.5g/dL (hematocrit <32%) in the 2nd trimester; results from increased plasma.
• Iron deficiency is the most common anemia in pregnancy (15-25% of pregnancies); low serum levels confirm it.
• Prevention includes iron supplements and a diet rich in iron and vitamins.
• Folic acid deficiency can lead to neural tube defects in the fetus
• Management includes folic acid supplements and foods with high folic acid.

Diabetes Mellitus, GDM, and Glucose Testing

• An endocrine disorder where the pancreas cannot produce adequate insulin to regulate body glucose.
• Gestational Diabetes Mellitus (GDM) is abnormal glucose metabolism arising during pregnancy.
• Obesity, age over 25, history of large babies, unexplained losses, congenital anomalies, polycystic ovary syndrome, and a family history of diabetes are all GDM risk factors
• A fasting plasma glucose above 200 mg/dl or above is diagnostic for diabetes. Normal levels are 80-100 mg/dl.
• Oral Glucose Tolerance Tests (OGTT) involve fasting, blood draws, and glucose drinks to assess glucose tolerance.
• GDM is diagnosed if two or more OGTT blood samples are abnormal or the fasting value is above 95 mg/dl.
• Monitor a woman with diabetes, assess ophthalmic complications to avoid vision loss.

GDM Signs/Symptoms and Treatment

• Polyuria, polydipsia, polyphagia, and involuntary weight loss are all indicative of GDM.
• Diet and exercise decreases glucose; if those don't work. insulin can also be used.
• A 2-hour post-prandial dose, after eating, help control blood sugar spike.
• A woman with GDM will revert to normal glucose levels after pregnancy.
• Test creatinine to check kidney function to prevent preeclampsia and heart attacks.

Substance Abuse

• Inability to meet obligations, legal or risk taking behaviors: sign of substance abuse.
• Marijuana helps with morning sickness, frequent users do not get enough milk because drug excretion.
• Heroin: results in severe withdrawal symptoms in babies.

STI Symptoms

• Withdrawal symptoms include nausea, vomiting, diarrhea, abdominal pain, shivering, insomnia.
• Amphetamines cause teeth damage, jitteriness and poor feeding.

Contraction symptoms

• Pain, blood and elevated temperature sign of STI.
• Refer to the "help" hotline.

Rhematic fever

• Starts as strep throat.
• Treat before it becomes a bigger issue if caught early enough.

Gestational Conditions

• Hyperemesis Gravidarum is persistent sickness with the cause unkown.
• electrolyte imbalance is a diagnostic factor during an evaluation.
• Can have effects such as a decreased blood pressure, increased pulse rate or poor skin turgor.

Incompetent Cervix

• Cervix open easily at 4th-5th month of pregnancy.
• Put a stitch in you to keep it close.

Abortions

• There are a multitude of reason it can happen.
• Majority of those who do end up with spontaneous abortion are related to chromosomal abnormalities.

Placenta Privia

• There are different categories.
• A high-risk pregnant must tell doctors early during process.

Gestational Trophoblastic Disease

• Very rare as mole will grow and multiply in area.
• There as high-risk for Asian women.