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.