HIGH RISK PREGNANCY

This is a pregnancy with a higher than average risk of an adverse outcome for the mother or baby, e.g., abortion,
intrauterine death, still birth, prematurity, other morbidity or mortality.

High risk criteria: if a woman has history of or current

  • Extremes of reproductive age: <18 and >35 years
  • Primigravida: Especially if too young (<18 years), short (<150cm), or old (>35 years)
  • High parity: 5+ or short birth-to-pregnancy interval below 2 years
  • Maternal Obesity (BMI >30)
  • History of:
    • Large infants: 4 kg and over
    • Prematurity and Low birth weight (LBW) <2.5kg
    • Obstructed and difficult labours
    • Instrumental delivery
  • Poor obstetric history, e.g., stillbirths, neonatal deaths, abortions, caesarean section
  • History of reproductive tract surgery, e.g., VVF repair, repaired (ruptured uterus), surgery on the cervix,
    myomectomy
  • Genetic or familial diseases, such as sickle cell disease
  • Medical conditions: Diabetes, HIV, cardiac, renal, hypertension, rhesus, those with disabilities
  • Obstetrical conditions, e.g. multiple pregnancy, malpresentations, APH, PPH, DVT, IUGR, PROM, post
    dates, CPD

MANAGEMENT

Principles of management

  • Early identification of high risk pregnant women and referral as appropriate
  • Preconception care and folic acid supplementation
  • Prophylaxis and antenatal counselling will prevent some HRPs
  • Early start of antenatal care
  • Close medical supervision during pregnancy
  • Special investigations to evaluate foetal development and maternal well-being
  • Birth preparedness plan
  • Timely intervention for therapy and delivery
  • Skilled birth attendance
  • Early referral to higher level as appropriate

Note: Skilled attendance at birth remains the most important component of comprehensive emergency
obstetric and new-born care.