This document discusses screening and management of high-risk pregnancies. It defines high-risk pregnancy as one complicated by factors that adversely affect pregnancy outcomes. Initial screening assesses medical and reproductive history, physical exam, and identifies risk factors like maternal age, weight, previous complications. High-risk scoring assigns points to risk factors to determine level of risk. Management of high-risk cases and labor involves additional monitoring, testing, potential induction or c-section based on conditions present.

2. Presented
By-
Mandeep
kaur

3. DEFINITION:
High risk pregnancy is defined as
one which complicated by factor
or factors that adversely affects
the pregnancy outcome.

4. The cases are assessed at the initial antenatal
examination. This examination may be
performed in a big institution or a
peripheral health centre. In few areas, the
initial screening may be done by properly
trained personnel.

5. (A) HISTORY:-
Maternal age
Reproductive
history
Medical or surgical
disorders
Family history

6. (B) EXAMINATION:-
General physical examination
• Height
• Weight
• Anemia
• Blood pressure
• Cardiac or pulmonary disease
Pelvic examination
• Uterine size
• Genital prolapsed
• Lacerations or dilatation of cervix
• Pelvic inadequacy

7. Patients having
no antenatal care
Anemia Pre-eclampsia Or
Eclampsia
Premature or
prolong rupture of
membranes
Amnionitis Meconium stained
liquor

8. Abnormal
presentation and
postion
Disproportion,
floating head in
labor
Multiple
pregnancy
Premature
labor
Abnormal fetal
heart rate
Rupture
uterus

9. Prolonged
labor
Obstructed
labor
Induced
labor
Acceleration
of labor

10. PPH
Shock
Sepsis
Retained placenta
Apgar score below 7
Hypoglycaemia
Birth weight more or
less
Fetal infections
Perisistent cynosis

11. RISK FACTORS SCORE
1. AGE LESS THAN 18 years
or more than 35 years
1
2. Maternal height less than
145cm
1
3. Primi or multi more than 5 1
4. Bad obstetrical history 2
5. History of neonatal
jaundice or Rh ABO
incompactibilty
2

12. 6. Weight less than 45 kg
or more than 90kg
1
7. History of low birth
weight
1
8. Previous uterine surgery 2
9. History of APH and PPH 2
10.History of manual
removal of placenta
2

13. 11. Anaemia (less than
6 gm%)
3
12. Febrile ailment in
pregnancy
1
13. Pregnancy
associated with
hypertension
2
14. Medical condition
with pregnancy
2
15. Bleeding P/V (APH,
Abortion)
2
16. Abnormal 2

14. 17. Maturity less than 37
weeks or more than 45
weeks
2
18. PROM 2
19. Fetal distress 2
20. Prolonged labor twenty
hours
2
21. Uterine size less than
period of gestation
2
22. Dai handling/ outside
interference
2 or 3

15. In community settings:-

16. Cont….

17. Antena
tal visit
Vaginal
examina
-tion
Previous
history of
first
trimester
abortion
Premat-
ure
labor
intrauterine
growth
restriction
Un-
explained
still
birth
Assessment of maternal and fetal well being:

18. • Pre planned
caesarean
section
• Induction of
labor

19. Fetal heart rate
Presence of meconium
in the liquor
Fetal scalp blood

20. 1. Fatal conditions
2. Serious conditions
3. Minor condition

21. Definition
SCREENING OF HIGH RISK CASES
INITIAL SCREENING
COMPLICATIONS OF LABOUR
HIGH RISK SCORING OF PREGNANCIES
MANAGEMENT OF HIGH RISK CASES
MANAGEMENT OF LABOUR

22. QUERIES