High risk pregnancy

Question 1

Who is ‘high risk’ during pregnancy (increased risk of adverse outcome) (5 categories)

Answer 1

• Maternal conditions
• Social factors
• Obstetric issues in previous pregnancy
• Problems in this pregnancy
• Problems during labour

Question 2

List some maternal conditions that would make a person ‘high risk’ during pregnancy

Answer 2

Maternal ‘high risk’ factors

• diabetes
• obesity
• hypertension
• chronic disease
• infections
• previous surgery
• VTE

Question 3

List some social factors that would make a person ‘high risk’ during pregnancy

Answer 3

Social ‘high risk’ factors

• teenage pregnancy
• maternal age >40 years
• high parity with low inter pregnancy interval (PPH-oxytocin infusion to reduce risk by encouraging uterus to contract)
• poor SES conditions
• smoking/drugs/alcohol

Question 4

List some past obstetric conditions that would make a person ‘high risk’ during pregnancy

Answer 4

Past obstetric conditions

• past caesarian section (risk of uterine rupture-advice VBAC)
• pre term delivery
• recurrent miscarriage (3 consecutive)
• stillbirth
• pre eclampsia
• gestational diabetes
• third degree tear

Question 5

List some problems during current pregnancy that would make a person ‘high risk’ during pregnancy

Answer 5

problems during this pregnancy

• placenta previa
• pre-eclampsia
• gestational diabetes
• multiple pregnancy
• small for gestational age

Question 6

List some problems during labour that would make a person ‘high risk’ during pregnancy

Answer 6

Problems during labour

• meconium/blood stained liquor
• worrying CTG
• oxytocin infusion
• lack of progress (oxytocin infusion, instrumental delivery, C section)

Question 7

Who provides care for uncomplicted vs high risk?

Answer 7

Uncomplicated
-Midwife/GP led

High risk
-Shared care -Consultant and midwife

(decided after risk assessment at booking visit)

Question 8

Managment of high risk pregnancy?

Answer 8

High risk pregnancy

Counselling – mode of delivery, weight
Special investigations – GTT (glucose tolerance test)
Scans – Growth scans
Sp. Clinics – E.g. Obstetric Diabetic Clinic
Anaesthetic Review – BMI
Close observation – Diabetes, blood pressure

Question 9

When would you do a glucose tolerance test?

Answer 9

Glucose tolerance test

• PMH of gestational diabetes (do at 16 weeks and 26 weeks)
• If their BMI>30 (obese) do GTT at 26 weeks

Question 10

If a women has never had VTE herself but her mother had DVT in her pregnancy, is she high or low risk?

Answer 10

• Strong family history of (oestrogen provoked) VTE-may have inherited thrombophilia
• High risk- consultant led-do thrombophilia screen

Question 11

How many miscarriages makes someone high risk?

Answer 11

3 consecutive miscarriages (unless she is older years, 2 is high risk)