HIGH RISK PREGNANCY SCREENING AND ASSESSMENT - NURSING ASSIGNMENT
INTRODUCTION
All
pregnancies and deliveries are potentially at risk. However there are certain
categories of pregnancies where the mother the fetus or the neonate is in a
state of increased leopardy. About 20 to
30 percent pregnancies belong to high category. If we desire to improve
obstetric results, this group must be identified and given extra care. Even
with adequate antenatal and intranatal care, this small group is responsible
for 70 to 80% of perinatal mortality and morbidity.
HIGH
RISK PREGNANCY
DEFINITION
High risk
pregnancy is defined as one which is complicated by factor or factors that
adversely affects the pregnancy outcome – maternal or perinatal or both.
SCREENING
OF HIGH RISK CASES
·
The cases are assessed at the initial antenatal
examination, preferably in the first trimester of pregnancy.
·
Risk factors may later appear and are detected
at subsequent visits.
·
The initial screening may be done by properly
trained paramedical personnel.
INITIAL
SCREENING
HISTORY
Maternal
Age
Pregnancy
below the age of 17 or above the age of 35 years. Primegravida above the age of
30 years. Pregnancy is safest between the ages of 20-29 years.
Reproductive
History
Second and
third pregnancies after a normal first delivery carry the low risk.
The
High Risk Factors in Reproductive History are;
·
Two or more previous abortions or previous
induced abortion
·
Previous still birth, neonatal death or birth
of babies with congenital abnormality
·
Previous preterm labour.
·
Ground multipartly
·
Previous caesaren section or hysterotomy
·
Pre-eclampia and eclampsia
·
Anaemia
·
Previous infant with Rh-isoimmunisation
·
Medical or surgical disorders
o
Tuberculosis
o
Pygelonephritis
o
Thyroid disorders
o
Cardiac disorders
o
Epilepsy
o
Viral hepatitis
In all these
conditions, fetal or maternal outcome or both may be affected.
Family
History
Socio-economic
Status:
Patients
belonging to poor families have a higher incidence of anemia, preterm labour,
growth retarded babies and so on. Working women who have to undertake long road
journeys, have a higher incidence of abortion or premature labour. Family
history of diabetes, hypertension or multiple pregnancy (maternal side),
congenital malformation.
EXAMINATION
General
Physical Examination
·
Height: Below
150 cm particularly
Below 145 cm in our country
·
Weight : Over
weight or under weight
Bodymass
index = Weight/Height
BMI
– 20 to 24 is normal
·
High Blood Pressure
o
Normal BP -
120/80 mm of Hg
o
High BP - 140/90 mm of Hg
o
Low BP - 90/60 mm of Hg
·
Anaemia :
o
Normal haemoglobin – 10.5 gm/dl
o
HB level below 10 gm/dl at anytime
o
During pregnancy considered anaemia
·
Cardiac disorders
Eg: Rheumatic
Valvular lesions
Hypertension
Coronary
Cardiac Diseases
·
Pulmonary disorders
Eg: Tuberculosis
·
Psychatric Illness
Eg: Depression
Schizophrenia
·
Orthopaedic Problems
Eg: Tubercular
Arthritis
Congential
Dislocation of Hips
Kyphosis
Scoliosis
Pelvic
Examinations
·
Uterine size – Normal – 6.5 to 7 cm
·
Genital Prolapse
The incidence of prolapse is about 1 in
250 pregnancies. The effect of prolapse in pregnancy are abortion, intrauterine
infection, premature rupture of the membrane.
·
Dilation of the Cervix
Dilation of the cervix at birth is 10 cm
·
Pelvic Inadequacy
Pelvic abnormalities may make vaginal
delivery difficult or impossible. The six main causes of abnormal pelvic
measurements are heredity, infections, poor nutrition, accidents, paralysis of
one or both extremities and poor posture.
COMPLICATIONS
OF LABOUR
Certain
complications may arise during labour and place the mother or baby at a high
risk. Examples are
·
Intrapartum fetal distress
·
Delivery under general anaesthesia
·
Breech delivery
·
Failed forceps
·
Post partum haemorrhage
·
Retained placenta
·
Prolonged labour
MANAGEMENT
OF HIGH RISK CASES
·
The nurse should educate the mother about the
importance of routine and laboratory investigation done in early pregnancy.
·
The nurse should advice the mother to do all
the investigations to avoid the complications
·
The nurse should send the mother to the
investigations like hysterogram, hysteroscopy, laproscopy or transvaginal
ultrasonography to rule out mullerian abnormality (reproductive deformalities)
·
The nurse should send the mother for the
investigations of diabetes, hypertension, kidney disease or thyroid disorders.
·
The nurse should educated the mother about the
importance of treating sexually transmitted diseases before embarking on
another pregnancy. And also about the personnel hygine.
·
The nurse should advice the mother to take
folic and tablet 4 mg daily during pregnant state and is continued through out
the pregnancy. It avoid chromosomal abnormalities in the newborn and iron
deficiency to the mother and the child.
·
The nurse should advice the mother to take
nutritious diet, rest and medications regularly to have a healthy pregnancy.
·
The nurse should advice the mother to take
minimum mediums during pregnancy, particularly in the early month of pregnancy
with doctors advice, because the drug pass per placental.
CONCLUSION
High risk
pregnancy is defined as one which is complicated by factor or factors that
adversely affects the pregnancy outcome – maternal or perinatal or both. It
must remember that over 50% of all maternal complications and 60% of all
primary caesarean sections arise from the high risk group of cases.
BIBLIOGRAPHY
1. A
Text Book of Obstetrics
D.C.Dutta, 5th Edition
Page No.631-634
2. A
Myles Text Book of Obstetrics
14th Edition
Page No.731, 425
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