This document outlines various general and specific risk factors to consider when assessing a pregnancy. It discusses factors related to maternal age, weight, height, parity and socioeconomic status. It also discusses risk factors based on previous reproductive and medical history, complications in the present pregnancy, and previous surgeries. Various methods for monitoring the pregnancy through clinical, biochemical and biophysical means are also outlined.

1. General Risk Factors
These are the factors based on patient’s age, parity etc. and can be easily
recognized by a woman herself or her relatives.
• Maternal age: less than 19 or more than
35 years.
The problems such as abortion,
preeclampsia, and preterm delivery
increase when the age is less than 19
years. Similarly, problems such as
anomalies,gestational diabetes increase
after the age of 35 years.
• Parity: primigravida or grand
multigravida
There are specific problems with primi-like
hyperemesis, preeclampsia and with
multigravida-like malpresentation,
postpartum haemorrhage.
.
• Prepregnancy weight: less than 40 kg or more
than 90 kg
Very low weight predisposes to low birthweight
babies and obesity predisposes to gestational
diabetes, big baby and related problems during
delivery
• Height: short stature (<145 cm)
Shorter women are likely to have small pelvis
(birth canal) and may have cephalopelvic
disproportion and needs caesarean delivery. If
neglected mayland up in obstructed labour.
• Social class: low socio-economic status
Women belonging to this group are more prone
for anaemia, malnutrition and infections which
further complicate the pregnancy and fetal well-
being

2. Risk Factors Based on Previous Reproductive History
• Prolonged period of infertility
Those who have conceived after long period of infertility may
have complications depending upon the cause of infertility, for
example, women with PCOS may develop gestational
diabetes.
• Recurrent abortions- multiple reasons which cause recurrent
abortion and are prone for complications such as
preeclampsia, preterm labor and intrauterine fetal growth
restriction (FGR) in present pregnancy.
• Bad obstetric history (intrauterine/neonatal death in the
past) -look for the factors causing these problems in the past
and manage them during current pregnancy and deliver the
baby at an appropriate time.
• Congenital anomalies -Even though risk of recurrence of
chromosomal anomalies is less, one needs to rule out the
causes such as diabetes in subsequent pregnancies.
• Premature labour- recurs in 25% of cases. All known causes
should be ruled out in subsequent pregnancies
• Difficult delivery/instrumental delivery - is an indicator of similar
problems in the next pregnancy. Hence, one need to consider it as
high-risk Caesarean section
• Caesarean section is performed if there is a complication in the
mother or fetus. Those complications may repeat in subsequent
pregnancy. Also during pregnancy (rare) or labour the scar may
rupture..
• 3rd stage complications - postpartum haemorrhage, retained
placenta or inversion of uterus renders present pregnancy high-risk
• Preeclampsia/eclampsia/GDM -About 25% of these cases can recur
in subsequent pregnancies hence they are considered high-risk
• Birthweight of previous baby less than 2.5 kg/more than 4 kg----
Very small and big babies in the past suggest obstetric complications
that can repeat.
• Rh isoimmunization or ABO incompatibility -Once an Rh negative
group mother is isoimmunized all her subsequent pregnancies with
positive babies will run a risk of isoimmunization to thosbabies
• Genetic, Autoimmune and Medical disorders such as thyroid, heart,
blood, lung, liver, renal, neurological diseases.

3. Risk Factors in Present Pregnancy
• History of pain/bleeding any time (suggests
imminent abortion, ectopic pregnancy or preterm
labor).
• Poor/excessive weight gain (suggests FGR or
diabetes).
• Medical diseases such as hypertension, diabetes,
heart/respiratory/renal/hepatic diseases, anemia,
fever due to any cause (will have severe
consequences on maternal and fetal health).
• Multiple pregnancy – twins/triplets (most of the
complications seen in a pregnancy may occur in
multiple pregnancy).
• Intrauterine growth restriction/big baby (both run
the risk of sudden intrauterine death and postnatal
complications).
• Pre labour rupture of membranes/preterm labour
(will have complications of premature baby).
• Antepartum haemorrhage:
Abruption – Separation of normally situated placenta (both
mother and baby will have severe complications including
fetal death and maternal coagulation disorder)
Placenta previa – Low lying placenta after 7 months
• Oligo-/polyhydramnios
• Malpresentation – Breech/transverse lie (difficulty at
delivery is anticipated. Hence, both need institutional
delivery)
• Suspicion of cephalopelvic disproportion/abnormal pelvis
(needs caesarean section else obstructed labour can occur)
• Prolonged pregnancy – one that goes beyond expected
date of delivery placental reserve comes down and fetus is
at more risk

4. • Risk Factors due to Previous Surgeries
Any surgery in the past namely; previous caesarean
section, myomectomy,Laparotomy for any reason,
surgery for prolapse uterus, vesicovaginal fistula,
complete perineal tear and stress incontinence
renders the present pregnancy at high-risk as one
may anticipate recurrence of the problems for which
the surgery may have been done
• Risk Factors due to Complications During Labour
• Prelabour rupture of membrane
• Cord prolapse
• Prolonged labour
• Meconium-stained liquor
• Retained placenta
• PPH
• Acute inversion
• Injury to genital tract
• Ruptured uterus

5. others
• Smoking/tobacco chewing
• Alcohol/drugs
• Sedentary lifestyle
• Heavy work/travelling
• Neoplasms and malignancies

6. Identification of medical disorders in pregnancy
Pregnancy monitoring methods fall into the
following categories
• Clinical monitoring
• Biochemical monitoring
• Biophysical monitoring
clinical
• Counting methods- fetal movements
1. Cardiff Kick count to ten (10)
• In this method, mother is asked to note the time taken for 10
movements
• Movements to be counted are constant (10)- the time taken
maybe variable from one fetus to other, however a given
fetus must take same time every day.
• If the fetus takes more time subsequently, then it is
interpreted as decreased fetal movements as fetal hypoxia is
setting in.
2. One hour Kick count, three times a day
In this method, the time is kept constant, that is 1 h in the
morning, 1 h in the afternoon and 1 h in the night

7. clinical
• Abnormal presentations go hand in hand with other
obstetric abnormalities such as low lying placenta,
contracted pelvis and uterine developmental anomalies,
which require evaluation.
• Amniotic fluid
• Blood pressure
Biochemical monitoring
• Blood gp and type ,URINE ROUTINE, C/S, GBS TEST IN URINE
• CBC
• Blood glucose
• Hepatitis B and C
• HIV
• STIs like syphilis, gonnorhoea, chlamydia
• TFT
• maternal serum α-fetoprotein
• Maternal serum β-hCG
• Amniocentesis
• cordocentesis

8. Biophysical monitoring
• Electronic FHR recording and
ultrasonography
• Antepartum electronic fetal
monitoring

9. KNOW THE IMMUNISED STATUS