Risk Factors in Pregnancy

Risk Factors in Pregnancy

• High-risk pregnancies jeopardize the life or health of the mother or fetus
• The high-risk status for the mother extends through puerperium, which is 4 to 6 weeks after childbirth
• Maternal complications usually resolve within 1 month after birth
• A high-risk diagnosis can cause a family crisis
• Determinants of health and regionalization of health care services are risk factors
• The Canadian Perinatal Surveillance System monitors risks

Genetic Risk Assessment

• Heritable factors originate within the mother or fetus
• Examples include Trisomy 18 and Trisomy 21

Demographic Risks

• Demographic risks result from geographic location, socioeconomic status, racial disparity, and occupational hazards

Obstetrics and Gynecology NCBI 2018

• Nulliparous women with singleton gestations who are non-Hispanic Black are more likely to experience preterm birth, hypertensive disease, and SGA birth.

Maternal Health Problems

• Factors related to maternal death include hypertension, diabetes, infection, hemorrhage, or age, especially under 20 or over 35 years
• Other factors include lack of prenatal care and low education attainment

Risk Factors

• Risk factors include being over age 35, African-American, or obese
• Additional risk factors are having previous pregnancies, diabetes or kidney disease, high blood pressure, or a history of preeclampsia

High Risk Events

• Hypertensive disorders, diabetes, and hemorrhage are high-risk events

Hypertensive Disorders

• Types include hypertensive, pregnancy-induced hypertension, preeclampsia, eclampsia, and HELLP
• The PREECLAMPSIA CLASSIC TRIAD includes the following:
• Proteinuria or protein creatinine ratio greater or equal to 0.3 or dipstick of 1+
• High blood pressure that is 140/90 millimeters of mercury(mm Hg) or greater- at least four hours apart
• Sudden weight gain and selling- particularly in the face and hands-and pitting edema

Eclampsia

• Eclampsia is characterized by convulsions, along with signs of pre-eclampsia
• Convulsions can occur regardless of the severity of hypertension
• Convulsions are difficult to predict and typically occur in the absence of hyperreflexia, headache, or visual changes
• Convulsions are tonic-clonic and resemble grand-mal seizures of epilepsy, recurring in a rapid sequence, as in status epilepticus, and can result in death

HELLP Syndrome

• Acronym stands for Hemolysis, Elevated Liver Enzymes, Low Platelets

Diabetes Risk Factors

• Risk factors for diabetes include being 35 years of age or older, or being from a high-risk group such as African, Arab, Asian, Hispanic, Indigenous, or South Asian
• Other factors are using corticosteroid medication, obesity (BMI ≥ 30 kg/m2), prediabetes, gestational diabetes in a previous pregnancy, or giving birth to a baby that weighed more than 4 kg
• Other factors are having a parent, brother, or sister with type 2 diabetes, and polycystic ovary syndrome

Diabetes Considerations

• Women with gestational diabetes should be encouraged to breastfeed immediately after birth for a minimum of 4 months to prevent neonatal hypoglycemia, childhood obesity, and diabetes for both mother and baby
• Women should be screened for diabetes with a 75g oral glucose tolerance test between 6 weeks and 6 months postpartum, and receive ongoing education regarding strategies to reduce the risk of developing type 2 diabetes

Hemorrhage Causes

• Causes include miscarriage, retained products of conception, placenta abruption, placenta previa, uterine rupture, and trauma

Placenta Previa

• Placenta previa can be classified into normal Placenta, marginal placenta previa, and complete placenta previa
• The placenta completely or partially covers the cervix

Placenta Previa Risk Factors

• Being under 20 or over 35 for pregnancy
• Women with prior pregnancies, multiple pregnancies or prior diagnosed case of placenta previa raise the risk up to 2-3%
• Prior uterine surgery may increase the risk of placenta previa

Fetal And Neonatal Health Problems

• Preterm and multiple birth rates are leading causes of neonatal morbidity and mortality
• Other causes of neonatal death include sudden infant death (SIDs), respiratory distress syndrome (RDS), and effects of maternal complications

Antepartum Testing

• Includes prenatal screening like the first-trimester screening (11-13 weeks), the second-trimester serum screening (15-20 weeks) otherwise known as IPS#2
• Integrated prenatal screening measures both tests and creates an at-risk response that is 90% accurate
• Ultrasonography includes indicators to use looking at fetal heart activity, gestational age, fetal growth, fetal anatomy, placental position and function, and grading of placental maturation

Biochemical Assessment

• The Coombs' Test detects antibodies against foreign red blood cells
• Amniocentesis involves sampling amniotic fluid using guided US to screen for developmental abnormalities in a fetus

Amniocentesis Maternal Complications

• Include hemorrhage, fetomaternal hemorrhage, infection, maternal Rh isoimmunization, labor, abruptio placentae, damage to intestines or bladder, and amniotic fluid embolism

Amniocentesis Fetal

• Includes death, hemorrhage, infection (amnionitis), injury from the needle, miscarriage or preterm labor, and leakage of amniotic fluid

Amniocentesis Indications

• Include genetic concerns, fetal maturity, fetal hemolytic disease, and meconium

Biochemical Assessment-cont

• Percutaneous umbilical blood sampling (PUBS) or cordocentesis can be done at 18+ weeks to get direct access to fetal circulation via needle insertion into a fetal umbilical vessel under ultrasound guidance
• Chorionic villus sampling (CVS) allows for earlier diagnosis
• CVS can be performed between 10 and 13 weeks of gestation by removal of a small tissue specimen from the fetal portion of the placenta
• Chorionic villi originate in the zygote, and the tissue reflects the genetic makeup of the fetus

Third-Trimester Assessment

• Involves indications, fetal movement counting, and fetal responses to hypoxia and asphyxia
• Nonstress test (NST) used for interpretation

Electronic Fetal Monitoring

• Biophysical profile (BPP) used for score interpretation
• Amniotic fluid volume (AFV), with abnormalities often associated with fetal disorders
• Doppler blood flow analysis to assess Doppler effect

Nursing Role in Antepartal Assessment for Risk

• Psychological considerations
• Patients undergoing antenatal assessments are often anxious
• Tests may show suspected fetal compromise and be deterioration of maternal condition
• Third-trimester women are concerned about protecting themselves and their fetuses and consider themselves vulnerable

Psychological Implications of High-Risk Pregnancy

• When diagnosed with a high-risk pregnancy, women and their families will likely experience stress
• Women may exhibit various psychological responses such as anxiety, low self-esteem, guilt, frustration, and inability to function