High risk pregnancy

1. HIGH RISK
PREGNANCY

2. DEFINITION
High risk pregnancy is defined as
one which is complicated by
factors that adversely affects the
pregnancy outcome—maternal or
perinatal or both.

3. SCREENING OF HIGH
RISK CASES
INITIAL SCREENING
 Maternal age
 Reproductive history

4. REPRODUCTIVE HISTORY
 Two or more previous miscarriage
 Previous stillbirth
 Neonatal death or birth of babies
with congenital abnormalities
 Previous preterm labour or birth of a
IUGR or macrosomic baby

5. CONTT..
 Grand multiparity
 Previous caesarean section or
hysterectomy
 PPH
 Rh- isoimmunisation or ABO
compatibility

6. MEDICAL DISORDERS IN
PREGNANCY
Diseases—
 Pulmonary disease- tuberculosis
 Renal disease (Pylonephritis)
 Thyroid disorders
 Psychiatric illness
 Cardiac disease

7. CONTT..
 Epilepsy
 Viral hepatitis
 Pre-eclampsia, eclampsia
 Anaemia
 Infections in pregnancy (Malaria, HIV)

8. PREVIOUS SURGERY
 Myomectomy
 Repair of complete perineal tear
 Repair of vesico-vaginal fistula
 Repair of stress incontinence

9. CONTT..
 In all the conditions, fetal or maternal
outcome or both may be affected.
 Family history
 Socio-economic status

10. EXAMINATION
1. GENERAL PHYSICAL EXAMINATION
2. PELVIC EXAMINATION
 Uterine size- disproportionally smaller
or bigger
 Genital prolapsed
 Lacerations or dilatation of the cervix
 Associated tumors
 Pelvic inadequacy

11. SPECIAL TESTS

12. COMPLICATIONS OF LABOR

13. POSTPARTUM
COMPLICATIONS

15. RETAINED PLACENTA

16. SHOCK

17. NEONATAL COMPLICATIONS
 APGAR score below 7
 Birth weight less than 2500 g
 Birth weight more than 4 kg
 Convulsions
 Respiratory distress
 Hypoglycemia

18. CONTT..
 Sepsis
 Persistant cyanosis
 Anemia
 Major congenital abnormalities
 Jaundice

19. MANAGEMENT
 Preconception counseling
 Antenatal management
 Management of labor

20. THANK YOU