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- A careful history to reveal specific risk factors
- A maternal physical examination organized to identify or exclude risk factors
- Routine maternal laboratory screening for common disorders
- Special maternal laboratory evaluations for disorders suggested by any evaluative process
- Comprehensive fetal assessment by an assortment of techniques over the entire course of the pregnancy
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High-risk pregnancy is broadly defined as one in which the mother, fetus, or newborn is, or may possibly be, at increased risk of morbidity or mortality before, during, or after delivery. Factors that may lead to this increased risk include maternal health, obstetric abnormalities, and fetal disease. Table 12–1 provides an overview of some major categories that comprise a high-risk pregnancy.
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The purpose of this chapter is to outline basic and essential aspects of diagnostic modalities available for determination of pregnancies at risk that can be used in practice in a rational manner.
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The incidence of high-risk pregnancy varies according to the criteria used to define it. A great many factors are involved, and the effects of any given factor differ from patient to patient. Outcomes can include mortality of the mother and/or the fetus/neonate. Leading causes of maternal death include thromboembolic disease, hypertensive disease, hemorrhage, infection, and ectopic pregnancy. The leading causes of infant mortality (death from birth to 1 year of age) are congenital malformations and prematurity-related conditions. Although there is variation in definition depending on the resource, a perinatal death is one that occurs at any time after 28 weeks' gestation through the first 7 days after delivery. The perinatal mortality rate is the number of perinatal deaths per 1000 live births. Preterm birth is the leading cause of perinatal morbidity and neonatal mortality.
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In assessing pregnancies to determine risk, several key concepts may offer tremendous insight. Human reproduction is a complex social, biochemical, and physiologic process that is not as successful as once thought. Approximately half of all conceptions are lost before pregnancy is even recognized. Another 15–20% are lost in the first trimester. Of this latter group, more than half have abnormal karyotypes and defy current methodologies for prevention of loss. However, many other causes of reproductive loss are amenable to diagnosis and treatment. In this chapter we discuss the indications and justifications for antepartum care and intrapartum management.
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Preconception evaluation and counseling of women of reproductive age has gained increasing acceptance as an important component of women's health. Care given in family planning and gynecology centers provides a potential opportunity to maximize maternal and fetal health benefits before conception. Issues ...