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High risk pregnancy4
This document discusses identifying and managing high-risk pregnancies. It defines a high-risk pregnancy as one with maternal complications or obstetric risk factors that could threaten the life of the mother or baby. Conducting risk assessments during antenatal care allows early detection of issues and timely referral for specialized care. Key aspects of managing high-risk pregnancies include monitoring for common risks like hypertension and bleeding, providing appropriate medical treatment, and arranging delivery at tertiary care centers that can handle emergencies. A multidisciplinary team approach involving education of mothers is emphasized to provide the best care and reduce mortality risks.
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High risk pregnancy4
- 1. Detecting High Risk Pregnancy Dr.Varsha L. Deshmukh Assoc. Prof & Unit Incharge Govt. Medical College, AURANGABAD
- 2. Introduction • Pregnancy includinglabour & delivery is itself a high risk event. • The aim of risk assessment is to identify the factors that may constitute greater than average risk to a pregnancy. • This permits the prediction of potential adverse pregnancy outcomes & enables the process of selecting women who may benefit from extra researches.
- 3. Receiving quality antenatal, intranatal& postnatal services is one of the reproductive rights of women
- 4. Introduction • It isimpossible for the process of risk assessment to predict every perinatal event. • WHO recommends that a risk assessment approach be used in the mgt. of maternal, fetal health care. • It also suggest arrangement for delivery at tertiary care center for high risk obst. pts. .
- 5. Aim • To identifywomen with maternal complications & obst. risk factors.
- 6. Why to Identifyor Detect Women with High Risk Factors
- 7. • It willreduce the number of cases brought in a state of emergency when t/t is most difficult & least effective. • If t/t is started in time, it is possible to save life of both mother & baby. • Timely referral after appropriate medication is important improving the prognosis.
- 9. Maternal Mortality Major causesof maternal mortality are • PIH • Eclampsia • APH • PPH • Puerperal sepsis • Obstructed labour • Unsafe abortions
- 10. Maternal mortality isa gender issue & speaks about the status of women in the society. Maternal mortality is an equity issue as maximum maternal death are reported from people living below poverty line from under privilege community
- 11. Except for hemorrhageother causes of maternal mortality can be identified & treated effectively, thus maternal mortality can be greatly reduced.
- 12. Obstetric Emergencies The obst.emergencies are life threatening • Fatality rate is more • Difficult to treat • Surgery rate is increased • BT rate is increased • Hospitalization prolonged • Morbidity more
- 13. Cost Effectiveness • Earlydiagnosis leads to less emergencies hence less drug requirement & less morbidity • Thus the risk assessment system along with timely referral is highly cost effective.
- 14. What to Do? 1. Early diagnosis 2. Community awareness about antenatal care 3. Early initiation of appropriate therapy 4. T/t plan stream lining 5. Early identification 6. Timely referral
- 15. What to Tell? Every clinic must emphasize the following 1. ANC it is essential need 2. Eat more 3. Rest more 4. Get immunized (Inj TT) 5. Take Tab. FS 6. Hospital delivery
- 16. Ante-natal care • Periodiccheck-ups • Risk factors identified on time • Treatment started early • Hospital delivery • Maternal complications diagnosed early • Maternal & fetal mortality less
- 17. Early Registration • Early– before 12 wks (preferably) • Before 20 wks • At 32 wks • At 36 wks • Encourage to visit more often in 3rd trimester
- 18. ANC • Careful history •Physical examination • Pregnancy progressing normally • Complications if occurs diagnosed early • Timely referral • Institutional delivery
- 19. History • LMP/EDD • Ageof the patient < 18 yrs. > 35 yrs. • Order of pregnancy primigravida or grand multi. • Interval of < 2 yrs since last pregnancy • H/o cardiac disease, diabetes, chronic hypertension
- 20. Past Obst. History •Parity • H/o still birth • IUFD • BOH • Preterm labour • Macrosomic baby • IUGR baby • Sev. PIH
- 21. Life Threatening Situations •H/o PPH • H/o APH • H/o MRP • H/o Eclampsia/HELLP • H/o Other complications associated with pregnancy which were life threatening
- 22. Complaints • Breathlessness • Excessivetiredness • Palpitation • Puffiness of face • Headache • Blurring of vision • Bleeding p/v • Leaking p/v • Pain in abdomen
- 23. Physical Examination • Maternalweight • Maternal height < 140 cm • Look for pallor, puffiness of face, oedema of feet. • Blood pressure 120/80 mmHg > 140/90 mmHg after 20 wks. S/o PIH
- 24.
- 25. Abdominal Examination • Abdominalexamination is done to monitor the progress of pregnancy, fetal growth, fetal lie and fetal presentation. • Height of uterus 12 wks just palpable 24 wks at umbilicus 36 wks at xiphisternum
- 26.
- 27. Fetal Lie • Vertical •Transverse • Oblique
- 28. Fetal Presentation • Vertex • Breech •Shoulder • Cord • Hand • Compound
- 29. FHS • Normal 120-160b.p.m. • Fetal tachycardia > 160 b.p.m. • Fetal bradycardia < 120 b.p.m. • Loss of fetal movement • Passage of meconium • All suggestive of fetal distress
- 30. Advise to Mothers •Food and rest
- 31. Advise to Mother •Anaemia prophylaxis • Tab. FS + FA 100 mg 1OD x 3 mths. • S/o anemia present - Tab. FS + FA 100 mg one B.D. x 3 mths. • Tab. Mebendazol 1 B.D. x 3 days. • Dietary advise
- 32. Advise to Mother •TT immunization • Preparation for labour
- 33. Laboratory Test • Anemia(Hb < 10 gm%) • Rh –ve blood group • Blood sugars • HIV • Hepatitis B • Urine microscopy
- 34. Current Pregnancy Status •Multiple gestation • Vaginal bleeding • Decreased fetal movements • Preterm labour or cervical change • PIH • Abnormal uterine size (IUGR/V mole) • Abnormal amniotic fluid volume • Postdatism
- 35.
- 36. Low Risk Labour •Spontaneous onset at 37 to 40 wks • Single fetus with vertex presentation • Estimated fetal weight average • Normal vital signs • No pregnancy complications • No abnormal intrapartum bleeding
- 37. Normal Low RiskLabour • Acceptable rate of cervical dilatation • FHS normal • Head engaged at full dilatation • Normal delivery within 2 hrs of good expulsive force • Third stage < 30 min • Total blood loss < 500 ml
- 38. High Risk Labour •Abnormal FHS • Meconium stained liquor • Malpresentation • Intrapartum hemorrhage • PROM • Instrumental delivery • PIH
- 39. High Risk Labour •Multiple pregnancy • Cord prolapse • Fetal macrosomia • Dysfunctional labour • Previous LSCS • Prolonged labour • CPD • Rupture uterus • Chorioamniotis
- 40. Labour 5 Cs • Cleanhands • Clean surface • Clean razor • Clean cord tie • Clean cord stump
- 41.
- 42. Partogram • Cervical dilatation •Descent of head • Uterine contractions • Drugs given • Fetal heart rate record
- 43. Partogram • Concept ofalert line • Concept of action line • Assessment of maternal condition • Assessment of fetal condition • Timely referral
- 44. Each and everyone working in the health department is committed to reduce the maternal mortality and to realize the reproductive rights of a women.
- 45. Obst. Emergencies • ANC • Anemia •PIH • Eclampsia • Placenta previa • Abruptio placenta • PPH • Retained placenta • Malpresentations • Obstructed & prolonged labour • Rupture uterus
- 46. Referral Obst. Emergencies •Position of the patient • Left lateral position • Mouth gag • Start IV fluid – ringer lactate • First dose of broad spectrum antibiotics • Other specific medication as indicated e.g. inj. MgSo4 in eclampsia • Breast feeding to be continued during transfer in cases of PPH
- 47. Referral Note • Shouldmention salient points about the history • Main clinical findings • Medications (dose, route, time of administration) • If telephonic facility is available should alert the referral hospital
- 48. Advise to FamilyMembers • About high risk situation • About blood donation • About financial aspects • Blood donors • Senior members for consent
- 49. Referral • Should betransported by the quickest mode of transport • 3 delays
- 50. Through a teamapproach all of the skills of the health care members involved can be combined to provide the best possible approach to meet the pregnancy’s need. The role of patient education can not be over emphasized. Incorporating the mother as an active member in her health care is an investment in time and effort that is cost effective both during pregnancy and labour.
- 51. A systematic &a well begun programme with a positive thinking will definitely show road to success to accept this challenge