Every year there are an estimated 200 million pregnancies in
the world. Each of these pregnancies is at risk for an adverse
outcome for the woman and her infant.. Every minute of every day, a
woman dies somewhere as as a result of pregnancy or childbirth In
developing countries 99% of women die every year from complications
during pregnancy or childbirth.
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The 2000 National Maternal Mortality Study (NMMS)
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it is generally thought of as one in which the mother or the
developing fetus has a condition that places one or both of them at
a higher-risk for complications, either during the pregnancy
(antepartum), during delivery (intrapartum), or following the birth
(postpartum)
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Risk Factors:- Risk factors include 1) preexisting maternal
disorders 2)problems in previous pregnancies 3)and problems that
develop during the pregnancy or during labor and
delivery.pregnancy
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Environmental factors: Living area. Bad sanitation (water, air,
food). Present of MCH centers. Culture factors: No access to
prenatal care. Wrong concepts (diet, hygienic care, pre married
assessment).
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1)Illiterate 2) Being a smoker. 3) Exposure to teratogens 4)
Using alcohol. 5) Low socioeconomic status.
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0-3 low risk 4-7 Moderate risk 8-10 high risk
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1.High parity 2.Short birth intervals 3.Twins 4.Preterm births
5.Anemia. 6.Diabetes mellitus 7.Maternal age of 30 years and older
1.Low average age of marriage 2.Illiteracy 3.Lack of prenatal care.
4.Poor health information systems
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Preventive Measures Reducing High Risk Pregnancy The nursing
role in the assurance of maternal and child health can be divided
into four phases: The first phase is before the occurrence of
pregnancy during examination of the patient seeking pregnancy The
second phase is during antenatal care The third phase is that of
childbirth care and the fourth phase is puerperium
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1)Physical and socio-demographic characteristics. 2) Previous
pregnancies. 3) Medical diseases. 4) Present pregnancy or during
labor and delivery.
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Previous stillbirth Previous neonatal death Previous premature
infant Previous post-term (over 42 weeks) Pregnancy. Repeated
miscarriages. Previous infant over (4.5 kg). Grand multipara.
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History of preeclampsia. History of eclampsia. Previous
cesarean section. History of a fetus with anomalies
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A pregnant woman with any of the following medical conditions
would be considered at risk: Heart disease (class II-IV,(
symptomatic( Insulin-dependent diabetes. Chronic hypertension.
Moderate to severe kidney disease. Endocrine gland removal sickle
cell disease.
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History of tuberculosis Positive serology for syphilis
Pulmonary disease Thyroid disease Family history of diabetes HIV.
Epilepsy.
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Abnormal fetal position Mild to severe preeclampsia Multiple
pregnancy Placenta abruption Placenta previa Polyhydramnios or
oligiohydramnios Gestational diabetes
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Vaginal spotting. Bladder infection. Emotional problems.
Moderate alcohol use. Smoking more than one pack per day. Infection
with parvovirus disease), cytomegalovirus (CMV), toxoplasmosis,
rubella.
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1.High parity 2.Short birth intervals 3.Twins 4.Preterm births
5.Anemia. 6.Diabetes mellitus 7.Maternal age of 30 years and older
1.Low average age of marriage 2.Illiteracy 3.Lack of prenatal care.
4.Poor health information systems
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Maternal (medical) disorders:
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Risk problem Effect on motherEffect on baby Hypertension
Preeclampsia to up to 50%. Eclampsia. Abruptioplacenta by 2 to 10%.
Preterm labor. Abortion. Fetal growth retardation. Congenital
anomalies. Preterm baby. Intrauterine fetal death. Diabetes
Pyelonephritis. Ketoacidosis. PIH. Abortion 1. Macrocosmic baby. 2.
Fetal growth retardation. 3. Hypoglycemia. 4. Congenital anomalies.
5. Preterm baby. STDs Bacterial virginities. Gonorrhea. 3. Risk of
Genital Chlamydial infection increase. 4.Preterm labor. 5.
Premature rupture of the membranes. 1. Fetal death. 2. Congenital
malformations. Severe disability. 4. Risk of transmission of HIV is
30 to 50% within 6 m Pyelonephritis 1. Preterm labor. 2. Premature
rupture of the membranes. 1.Acute respiratory distress syndrome. 2.
Fetal death. 3. Congenital malformations. Genital tract
abnormalities Dysfunctional labor. Cesarean section. 3.Uterine
fibroids 4.Placental abnormalities Fetal mal presentation., Fetal
death. 3. Congenital malformations. Cervical incompetence Preterm
delivery., 2. Uterine rupture in vaginal delivery. 3. Poor
obstetric outcomes. Preterm baby
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Physical and social-demographic factors:-
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Risk problem Effect on mother Effect on baby Maternal age 13%
of all pregnancies PIH Eclampsia. Diabetes. Chronic hypertension
Preterm labor. Anemia. Dysfunctional labor. Abruptio placenta.
Cervical insufficient. Preterm baby. Fetal growth restriction.
Stillbirth. Maternal weight Hypertension. Diabetes. Post term
pregnancy. Cesarean section Macrocosmic baby Preterm baby. Fetal
growth restriction. Stillbirth. Exposure to teratogens Abortion.
Infection (herpes simplex, viral hepatitis, rubella, varicella,
syphilis, toxoplasmosis, and cytomegalovirus). Fetal malformation.
Preterm baby. Stillbirth. Parity (Grandmultipara) Abortion. Preterm
labor. Anemia. PIH. Preterm baby. Low birth weight Stillbirth.
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Getting at least 400 micrograms of folic acid every day if she
thinks she could become pregnant, and continuing folic acid when
she does get pregnant. Getting proper immunizations. Maintaining a
healthy weight and diet, getting regular physical activity, and
avoiding smoking, alcohol, or drug use. Starting prenatal care
appointments early in pregnancy.
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Psychosocial Implications of High Risk Pregnancy. The woman who
has been diagnosed to be at risk during pregnancy experiences a
wide variety of emotions and the normal emotional changes of
pregnancy may be intensive. The woman maybe confused about : What
is actually happening to her body May fear having an abnormal child
May feel a loss of control over the pregnancy because her choices
regarding pregnancy and child birth have been limited by her
complications. Psychosocial Implications of High Risk Pregnancy.
The woman who has been diagnosed to be at risk during pregnancy
experiences a wide variety of emotions and the normal emotional
changes of pregnancy may be intensive. The woman maybe confused
about : What is actually happening to her body May fear having an
abnormal child May feel a loss of control over the pregnancy
because her choices regarding pregnancy and child birth have been
limited by her complications.
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Pre-pregnancy heath education would include dietary matters,
cigarette smoking, alcohol, contraception, pregnancy spacing and
the effect of infections such as German measles on pregnancy. The
patient is examined for conditions which require treatment before
the occurrence of pregnancy, such as severe anemia, tuberculosis,
epilepsy and uncontrolled diabetes mellitus.
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Aim of ANC The antenatal period gives the obstetrician an ideal
opportunity to observe, advice, diagnose, treat and correct any
abnormalities occurring in the pregnancy
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Third phase (Labor) Close adherence to conservative obstetric
principles are antepartum fetal monitoring, complete asepsis and
infection control measures, including antibiotic therapy in cases
of prolonged rupture of membranes and making management decisions
before or early in labor whenever circumstances permit
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The mother is still at risk for complications during the
immediate and late postpartum periods In order to minimize the risk
of immediate postpartum hemorrhage, the obstetrician must have a
clear plan of action. The placenta must be carefully examined and
the uterus carefully explored to rule out cervical or vaginal
laceration or retained products of conception
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The problem of maternal mortality and high-risk pregnancy
continues to be a major preoccupation of health authorities in a
number of countries, particularly because the overwhelming majority
of these deaths would be preventable if: Consider safe motherhood:
a matter of human rights and social justice. Delay childbearing.
Consider every pregnancy faces risk. Ensure skilled attendance at
delivery. Improve access to maternal health services. Improve the
quality of maternal health services. Prevent unplanned pregnancy
Address unsafe abortion. Measure progress.