High Risk Pregnancy Assessment and Management
High Risk Pregnancy Assessment and Management
High Risk Pregnancy Assessment and Management
PREGNANCY
ASSESSMENT AND MANAGEMENT
SCREENING AND
ASSESSMENT
Initial antenatal examination - in the first trimester of pregnancy.
Some risk factors may later appear and are detected at
subsequent visit.
The cases are also reassessed near term and again in labour for
SCREENING AND
ASSESSMENT
A. INITIAL SCREENING HISTORY
B. NON-INVASIVE SCREENING
C. INVASIVE SCREENING
5.PreEclampsia
Eclampsia
4.Grand multi
parity
3. Previous
preterm
labour or
birth of SFD
baby or
weight of
3.5kg or
more.
2. Previous
still birth,
neonatal
death or birth
of babies with
congenital
abnormalities
.
6. Anaemia
Risk
Factors In
Reproducti
ve History
1. Two or
more
previous
abortions or
previous
induced
abortion
7.Previous
Caesarean
section
8.Previous
infant with
Rh- iso
immunisation
or also
incompatibilit
y
1.
Pulmona
ry
disease
6. Viral
hepatitis
5.
Cardiac
disease
Medic
al
Surgic
al
Disord
ers
4. Renal
disease
2.
Thyroid
disorder
3.
Epilepsy
1.
Myomecto
my
4. Repair
of stress
incontinen
ce
Previou
s
Operati
on
3. Repair
of
complete
perineal
tear
2. Repair
of vesicovaginal
fistula
Family History
Socio-economic Status: Patient belonging to poor families
have a higher incidence of anaemia, preterm labour, growth
retarded babies and so on. Working women who have to
undertake long road journeys, have a higher incidence of
recurrent abortion or premature labor.
Family
history
of
diabetes,
hypertension,
or
multiple
Examination
General Physical
Examination
Height: Below 150 cm
Pelvic Examination
Uterine size Disproportionate
Genital prolapse
Under weight
High BP
Anaemia
Cardiac or pulmonary
disease
cervix
Pelvic inadequacy
B. NON INVASIVE
MONITORING
1. Radio Diagnostic Examination
2. Radiation Therapy
3. Magnetic Resonance Imaging
4. Ultrasound (Doppler)
5. Doppler For Fetal HR Monitoring
6. Transvaginal Ultrasonography
1. Radio Diagnostic
Examination
Every women child bearing potential Ask orally or
in writing, whether pregnant or have missed a period. If
any
uncertainty
about
pregnancy
Postponed
examination.
If pregnant special attention - Justification and
urgency of the radio diagnostic examination.
In pregnant women alternative diagnostic method
can be considered US or MRI.
1. Radio Diagnostic
Examination
Reduction to the radiation dosage by the fetus may be
2. Radiation Therapy
Evaluate the presence of pregnancy (women of
reproductive age) when radiation therapy is considered
for.
Appropriate lead shield to protect gonads of patient
undergoing radiation therapy.
If the patient is pregnant, she must be involved in
discussion and decision about radiation therapy.
2. Radiation Therapy
Termination of pregnancy should be considered if the
radiation dose would lead to severe effects.
Patients who have radiation therapy should not be
discouraged from having children.
3. MRI
MRI is a powerful imaging tool.
Does not expose patient to ionizing radiation.
MRI requires powerful magnetic field and a radio
frequency pulse to produces a diagnostic imaging.
3. MRI
MRI has some maternal safety issues - Metallic
biomedical implants or other metallic foreign bodies.
Foreign metallic materials embedded within patient
can have ferromagnetic properties that presents a
potential hazards.
4. Ultrasound (Doppler)
It is widely accepted and valuable diagnostic tool in
standard clinical practice.
No potential harmful effects in the offspring.
Recent trend colour flow imaging, power Doppler,
pulsed Doppler.
6. Transvaginal
Ultrasonography
It should be performed in first trimester with valid
medical reasons that benefit the mother and embryo.
7. Kick Chart
I. Cardiff count 10 formula
The patient count fetal movement starting at 9 am.
The counting comes to an end as soon as 10 movements are
perceived.
7. Kick Chart
I. Cardiff count 10 formula
She is instructed to report the physician if
Less than 10 movements occur during 12 hours on 2
successive days.
No movement is perceived even after 12 hrs in a single day.
7. Kick Chart
II. Daily Fetal Movement Count (DFMC)
Three counts each of one hour duration (morning,
noon and evening) are recommended.
The total counts multiplied by four is given daily (12
hours) fetal movement count.
7. Kick Chart
II. Daily Fetal Movement Count (DFMC)
If there is diminution of the number of kicks to less
of pregnancy.
C. INVASIVE MONITORING
1. CVP and Pulmonary Artery Monitoring
2. Oxygen saturation Monitoring
3. Hemodynamic Monitoring of Cardiac Output
4. Capnometry
pulmonary
oedema,
and
refractory
2. Oxygen Saturation
Monitoring
Oximetry
is
the
detection
of
oxygenated
and
deoxygenated blood.
The oxygenated Hb reflects more light of 60mm
whereas at 940mm deoxy Hb reflects infrared light
more strongly.
2. Oxygen Saturation
Monitoring
This allows the simultaneous acquisition of peripheral
signal from which are ratio of oxyhemoglobin to
deoxyhaemoglobin can be calculated and expressed as
a percentage of oxyhemoglobin saturators.
2. Oxygen Saturation
Monitoring
Oximetry
may
be
based
on
transcutaneal
Purpose
to
deoxygenations.
know
the
oxygenations
and
3. Hemodynamic Monitoring
of Cardiac Output
Hb monitoring is an integral part of ICU management
Important in case of severe haemorrhage, severe
preeclampsia and septic shock.
An adequate cardiac output is important in delivering
oxygenated blood to the peripheral tissues.
3. Hemodynamic Monitoring
of Cardiac Output
Low output will reflect either hypovolemia or
ventricular failure
Knowledge of the cardiac output will determine more
and will calculate the Hb value.
4. Capnometry
Exhaled gas can be evaluated using an infrared probe
and a photo detector set to detect CO2.
Purpose is to detect level of co2.
abortion
APH
Malpresentations
Anaemia
Prolonged labour
PPH
disorders,
Gonorrhoea
Chlamydial
infection
and
at
towns
with
obstetrician,
anaesthetist,
Anaesthetist,
Microbiologist,
Radiologist,
Geneticist,
and
Paediatric