Procedure of Serious Pregnancy: An Evidence-Based Approach

Certain conditions, called risk factors, make a pregnancy high risk. Maternal conditions can be identified with preconception counseling and from the maternal history. Maternal physical and social characteristics that can contribute to a high-risk pregnancy include: age younger than 15 years and older than 35 yearspre-pregnancy weight under 100 lbs (45 kg) or obesityheight under 5 ft (1.5 m)incompetent cervixuterine malformationssmall pelvisbeing a single womanbeing a smokerusing illicit drugshaving no access to early prenatal careusing alcoholhaving low socioeconomic statusFor women who do not have health insurance, obtaining early prenatal care is extremely difficult, and these same women are often from a socioeconomic level that prevents adequate or appropriate nutritional intake. There is a scoring system that can be used by healthcare professionals to determine the degree of risk for a pregnant woman, but it is difficult to rate risk by degrees. Nevertheless, identification of a high-risk pregnancy helps to ensure that those women who need the most care receive it.One of the initial factors to consider when evaluating risk is the obstetrical history. If this is not the woman's first pregnancy, outcomes of her previous pregnancies are of importance in relation to the outcome of this one. An obstetrical history with any of the following conditions would be considered high risk: previous stillbirthprevious neonatal deathprevious premature infantprevious post-term (over 42 weeks) pregnancyfetal blood transfusion for hemolytic diseaserepeated miscarriagesprevious infant over 10 lbs (4.5 kg)six or more completed pregnancieshistory of preeclampsiahistory of eclampsiaprevious cesarean sectionhistory of a fetus with anomaliesNext to be considered is the medical history factor. A pregnant woman with any of the following medical conditions would be considered at risk: abnormal PAP testchronic hypertensionheart disease (class II-IV, symptomatic)insulin-dependent diabetesmoderate to severe kidney diseaseendocrine gland removal or ablation by autoimmune diseasesickle cell diseaseepilepsyhistory of tuberculosispositive serology for syphilispulmonary diseasethyroid diseasefamily history of diabetesHIVother chronic diseasesautoimmune diseases, such as lupusCurrent pregnancy risk factors would be considered as follows: Most women will see one healthcare provider during pregnancy, either an obstetrician, a midwife, or a nurse practitioner. Women who have a medical problem may need to see a medical specialist as well. Women diagnosed with a high-risk pregnancy should seek the care of an expert in the field of high-risk obstetrics, called a perinatologist. Perinatologists have additional training beyond the education required for an obstetrician. They care for women who have pre-existing medical problems, women who develop complications during pregnancy, and women whose fetus has probl