High Risk Maternity Care

High risk pregnancy

Overview

• Concepts of High –risk Pregnancy, Delivery and Postpartum

- Deviation of normal pregnancy, delivery and postpartum

- Health risks related to pregnant women, fetus, neonate

- Complication of pregnancy, delivery and postpartumwith concurrent diseases

- Crisis of pregnancy woman, fetus and family

- Cause of maternal and fetus and infant death

3

2000Maternal deaths per 100,000 Live Births

Map of Maternal Mortality, Worldwide

Source: WHO, UNICEF, and UNFPA, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and

UNFPA, 2004.

2006 Population Reference Bureau

4

Infections

15%

Unsafe Abortion

13%

Eclampsia

12%

Obstructed Labor

8%

Other Direct

Causes

8%

Severe Bleeding

25%Indirect Causes

20%

Pregnancy and Childbirth-Related Deaths to Women, by Cause

Causes of Maternal Mortality

Note: Total exceeds 100 percent due to rounding.

Source: World Health Organization, The World Health Report 2005: Making Every Mother and Child Count, Geneva,

2005.

• Delay in decision to seek skilled care

• Delay in reaching care

• Delay in receiving care

Why do women die?

Delay in decision to seek skilled care:

1. Lack of knowledge

2. Social and cultural barriers

3. Acceptance of maternal death

4. Low status of women

Delay in reaching care:

1. Mountains

2. Rivers

3. Lack of transportation

4. Island home

Delay in receiving care:

1. Lack of supplies

2. Poorly trained workers

3. Lack of finances

4. Unloving attitudes

High Risk Pregnancy

1st term:• Abortion

• Ectopic Prergnancy

• Hydatidiform Mole

• Hyperemesis Gravidarum

2nd & 3rd term:• Placenta Previa

• Abruptio Placenta

• PIH(pregnancy induced hypertension)

- preeclampsia

- eclampsia

- HELLP syndrome

Other diseasesDiabetes mellitus

Cardiac diseases

Study Objectives of High Risk Pregnancy

• Definition of high risk pregnancy & identify range

• Assess of high risk factors related to pregnancy

• Maximize self care ability of herself

• Corporate family supports for pregnant women

• Relief health risk factors/suggest nursing intervention

Assessment ToolPrenatal Risk Indicator Form

Risk

ScoreRisk Indicator

Risk

ScoreRisk Indicator

Demograpbic Factors 3

5

3

1

1

2

poor nutrition

inadequate weight gain

(less than 12 Ib)

excessive weight gain

(more than 48 Ib)

Smoking more than one pack/day

Drug or alcohos abuse: history of

this prenancy

2

1

2

1

1

1

2

Maternal Age: 15 or under, 35 or over

Parity: Nulliparous

grand multipara

Race: Nonwhite

Marital status: Out of Wedlock

Economic status:

Dependent on public assistance

Prenatal care: First visit after 27 weeks

or less than 5 visitsMedical Factors

Obstetric Factors 1

2

2

7

2

7

2

5

7

7

3

7

1

7

1

5

3

1

3

2

5

1

1

1

5

Anemia: 8-10 g

under 8 g

Sickle cel trait

Sickle cell disease

Hypertension: mild

severe

Heart disease: Class I or II

Class III or IV

Heart failure: History of

This pregnancy

Diabetes: gestational

overt

Thyroid disease: history of

this pregnancy

Venereal disease

gonorrhea or syphilis: history of

this pregnancy

Cervical neoplasia

Urinary tract infection

afebrile: history of

this pregnancy

Urinary tract infection,

febrile: history of

this pregnancy

Psychilatric or neurologic problem:

history of

this pregnancy

Other medical condition(e.g., pulmonary

disease, severe influenza):

history of

this pregnancy

1

2

1

2

1

5

7

1

2

5

7

7

5

1

7

5

2

1

7

7

7

1

3

2

7

1

7

Infertility factors: less than 2 years

more than 2 years

Previous abortion: one

two or more

Premature or low birth weight infant:

history of one

history of two or more

this pregnancy

Previous excessive size infant:

one

two or more

Previous perinatal loss: one

two or more

Postterm, beyond 42 weeks: this prenancy

Previous cesarean delivery

previous congenital anomaly

Incompetent cervix

Uterine anomaly

Contracted pelvis

Abnormal presentation: history of

this pregnancy

Rh negative, sensitized

Polyhydramnios

Preeclampsia, mild, history of

this pregnancy

Preeclampsia, servere, history of

this pregnancy

Multiple pregnancy: history of

this pregnancy

Miscelaneous Factors Risk Score

1

5

2

Nutrition: more than 20% overweight

massive obesity

more than 10% under-weight

At first visit

At 36 weeks

On admission to labor and delivery