Care of At-Risk / High Risk

and Sick Mother

Prepared by:

ROSE EDEN U. TULOY, RN, MN

HIGH-RISK PREGNANCY

• concurrent disorder, pregnancy-related

complication or external factor
jeopardizes the health of the mother,
the fetus or both
Identifying Clients at Risk:
Assessment of RISK Factor
 Age (very young and old)
 Medical condition (pre and post pregnancy)
 Number of pregnancy, spacing between pregnancies
 Maternal habits/Lifestyle
 Obstetric/Gynecologic history
 Family history
FACTORS that categorizes a pregnancy
at HIGH-RISK:
1. AGE
– Adolescents younger than 15
✓ Increased Incidence of Low-birth-weight and preterm neonates
 anemia, labor dysfunction, and CPD, nutritional deficiency,
Increased Risk for PIH
– Nulliparas, who are aged 35 and older,
– Multi paras who are aged 40 and older
✓ Increased risk for placenta previa, Miscarriage, low birth weight
babies, Genetic defects.
FACTORS that categorizes a pregnancy
at HIGH-RISK:
2. Maternal Parity with at least one of the following:
– 8 years or more since last pregnancy (too far
apart)
– Pregnancy occurring within last 3 months of last
delivery (too close)
FACTORS that categorizes a pregnancy
at HIGH-RISK:
3. Medical conditions that exist before pregnancy

➢ Conditions such as high blood pressure; breathing, kidney,

or heart problems; diabetes; sexually transmitted diseases (STDs); or chronic
infections such as human immunodeficiency virus (HIV) can present risks for
the mother and/or her unborn baby.
✓ it's important to consult your doctor before you decide to become
pregnant. He may run tests, adjust medications, or advise you of
precautions you need to take to optimize the health of you and your baby.
FACTORS that categorizes a pregnancy
at HIGH-RISK:
4. Maternal Obstetric and Gynecologic History
of any of the following:
– Two or more premature deliveries or
spontaneous abortions
– One or more neonates born with gross
anomalies
– Pelvic Inadequacy or abnormal shaping
– Abnormal uterine structure/shape
– History of Placental Anomalies, Amniotic
Fluid Abnormalities, or Poor Weight Gain
FACTORS that categorizes a pregnancy
at HIGH-RISK:
• History of Gestational Diabetes Mellitus,
PIH, or Infection
• Lack of previous prenatal care or
preparation for labor and birth
• Poor self-care practices
FACTORS that categorizes a pregnancy
at HIGH-RISK:
5. Maternal Lifestyle and Habits
➢ Inadequate Nutrition = deficiency of iron – diet/weight (BMI)
➢ Exposure to toxic substances such as lead, organic solvents,
certain gasses (ex. Carbon Monoxide), and radiation = fetal
malformations
➢ Ingestion of over-the-counter and prescription drugs =
detrimental to the fetus
➢ Cigarette smoking = intrauterine growth retardation and low-
birth-weight neonates
➢ Involvement with substance abuse via injection = posing an
increase risk of infection with Hepa-B and HIV
FACTORS that categorizes a pregnancy
at HIGH-RISK:
6. Family History
– Some conditions and disorders,
such as family history of multiple
births, congenital diseases or
deformities, and mental
disability
– Family environment, such as
history of battery or abuse, lack
of support, inadequate housing,
or lack of adequate finances
Screening Procedure
✓ Early detection is key to providing the best
treatment for the mother and unborn baby.

✓ experts use the latest tools to diagnose,

monitor and treat health problems in
pregnant women and their unborn babies.
Diagnostic Test
➢ it is done to establish the presence (or
absence) of disease as a basis for
treatment decisions in symptomatic
or screen positive individuals.

➢ Non-invasive diagnostic test:

- Fetal Ultrasound
- Non-stress Test (NST)
- Contraction stress test
Maternal Blood Screen
➢ The maternal blood screen is a simple blood test.
➢ It measures the levels of two proteins, human chorionic
gonadotropin (hCG) and pregnancy associated plasma
protein A (PAPP-A).
➢ If the protein levels are abnormally high or low, there could
be a chromosomal disorder in the baby.
Alpha-fetoprotein screening (AFP)
• This blood test measures the level of alpha-fetoprotein in
maternal blood during pregnancy.
• AFP is a protein normally made by the fetal liver. It is in the
fluid around the fetus (amniotic fluid) and crosses the
placenta into your blood.
• Abnormal levels of AFP may be a sign of:
– Open neural tube defects (ONTD) such as spina bifida
– Down syndrome
– Other chromosome problems
FETAL ULTRASOUND

Obstetrical ultrasound is a useful clinical test to:

– establish the presence of a living embryo/fetus
– estimate the age of the pregnancy
– diagnose congenital abnormalities of the fetus
– evaluate the position of the fetus
– evaluate the position of the placenta as well as maturity
– determine if there are multiple pregnancies
– determine the amount of amniotic fluid around the
baby
– assess fetal well-being
ELECTRONIC FETAL MONITOR (EFM)

•
Oral Glucose Tolerance Test (OGTT)
• A glucose tolerance test is often done in weeks 24 to 28 of pregnancy.

• It measures levels of sugar (glucose) in your blood. Abnormal glucose

levels may be a sign of gestational diabetes.

• Screening with an oral glucose challenge test ( a fasting plasma glucose

level) is done; with 100grams is loaded to pregnant woman, after 1 hour
the blood sugar level is checked.

✓ Two abnormal levels or a fasting glucose level >95mg/dL confirms

diagnosis of GDM
Diagnostic Test
Invasive diagnostic test:
- Amniocentesis
- Chorionic Villus Sampling
- Percutaneous Umbilical Cordblood sampling
What steps can I take to promote a healthy
pregnancy?
Schedule a preconception appointment.
– health care provider counsel you to start taking a
daily prenatal vitamin and reach a healthy weight
before you become pregnant.

– If you have a medical condition, your treatment

might need to be adjusted to prepare for pregnancy.
What steps can I take to promote a
healthy pregnancy?
Seek regular prenatal care.
➢ Prenatal visits help you monitor your health and your baby's
health. Depending on the circumstances, you might be referred
to a specialist in maternal-fetal medicine, genetics, pediatrics or
other areas.

Eat a healthy diet.

➢ During pregnancy, you'll need more folic acid, calcium, iron
and other essential nutrients.
➢ special nutrition needs due to a health condition, such as
diabetes.
What steps can I take to promote a
healthy pregnancy?
Avoid risky substances.
➢ If you smoke, quit. Alcohol and illegal drugs are off-limits,
too.
➢ Get your health care provider's OK before you start to get
pregnant— or stop bad habits.
What steps can I take to promote a
healthy pregnancy?
Be cautious when using assisted reproductive technology (ART).
➢ If you're planning to use ART such as (In Vitro
Fertilization) to get pregnant, consider how many
embryos will be implanted.
➢ Multiple pregnancies carry a higher risk of preterm labor.
IVF (In Vitro Fertilization)
• During IVF, mature eggs are
collected (retrieved) from ovaries
and fertilized by sperm in a lab
• An egg is fertilized by injecting a
single sperm into the egg or mixing
the egg with sperm in a petri dish
• Then the fertilized egg (embryo) or
eggs (embryos) are transferred to a
uterus.