DIONGSON,JUSTINE KAYE B.

BSN3B

High-risk pregnancy: Know what to expect

High-risk pregnancy refers to a pregnancy where the mother or baby is more likely to develop
health problems before, during, or after delivery. This risk may require additional medical
appointments or tests, which are conducted by healthcare teams to detect and treat potential
health issues. Factors contributing to high-risk pregnancy include age, lifestyle choices, health
problems, and pregnancy complications. Age is higher for those under 20 or 35, while lifestyle
choices like alcohol consumption, smoking, and illegal drug use can increase the risk. Pregnancy
complications, such as unusual placenta location and low fetal growth, can also pose concerns.

High-risk pregnancy can be a stressful experience for both the mother and the fetus. Factors such
as Rh sensitization, multiples, infertility treatments, and a history of medical problems during
previous pregnancies can increase the risk of having a high-risk pregnancy. To ensure a healthy
pregnancy, schedule an appointment with your healthcare professional to discuss managing
medical conditions, taking necessary medications, and preparing for a healthy pregnancy.
Regular appointments with your healthcare team can help monitor your health and your baby's
health.

Avoid risky substances like tobacco or e-cigarettes, and don't drink alcohol or take illegal drugs
during pregnancy. Your healthcare professional may suggest special tests, such as ultrasounds,
cell-free DNA screening, amniocentesis, and chorionic villus sampling (CVS). These tests can
help identify genetic conditions and confirm results from cell-free DNA screening.

To manage any medical conditions during pregnancy, contact your healthcare team immediately
if you experience symptoms such as vaginal bleeding, watery vaginal discharge, pain or
cramping, less fetal activity, severe headaches, nausea, chills, chest pain, dizziness, weakness,
extreme tiredness, nervousness, overwhelming feelings of sadness, or thoughts of harming
yourself or your baby.

Having a high-risk pregnancy may be stressful and cause worry about your baby's health. It is
important to talk to your healthcare professional throughout your pregnancy for questions or
support, and after pregnancy, discuss how medical conditions during pregnancy might affect
your long-term health.

Detection of high-risk pregnancies in low-resource settings: a case study

in Guatemala
The Healthy Pregnancy project in Guatemala has significantly reduced maternal mortality rates
in two of the three highest-mortality departments, Alta Verapaz and San Marcos. The project has
identified a MMRP of 97.98 in Alta Verapaz and 102.77 in San Marcos, confirming the trend
detected in the first pilot project. The project has also improved the detection of obstetric
complications, with a rate of 16.43% of asymptomatic bacteriuria, 0.54% of multiple
pregnancies, and 14.87% of fetal malpresentation from week 32 onwards. However, the project
has faced lower results in glucose tests, requiring modifications to only test fasting women.
Overall, the Healthy Pregnancy project contributes to improving prenatal control for women in
rural areas.
The Healthy Pregnancy initiative in Guatemala aims to improve prenatal care by providing
equipment, training, and supervision to nurses responsible for prenatal controls in rural areas.
This strategy helps identify and refer obstetric risks in time, potentially reducing maternal
mortality. The EHAS Foundation is working to extend the project to other Guatemalan
departments and Latin America and Africa.

High-Risk Pregnancy and Pregnancy Complications

High-risk pregnancy can be classified into minimal, moderate, or extensive factors based on
psychological, social, and physical factors. Psychological factors include drug dependence,
intimate partner abuse, mental illness, loss of support person, poor acceptance of pregnancy,
severe fear of labor and birth experience, inability to participate due to anesthesia, newborn
illness, isolation, low economic level, poor access to transportation, poor housing, refusal or
neglected prenatal care, disruptive family incident, conception less than one year after last
pregnancy, lack of support person, inadequate home for infant care, and lack of access to
continued health care.

Pregnant women with special needs require more attention and care than average women
warrant. Caregivers must understand that pregnancy for them is much more challenging and
provide every bit of guidance to ensure a safe and less risky pregnancy. Teenage pregnancy is
rampant, and adolescents need special care and education from their caregivers to have a safe
and worry-free delivery.

Health history taking during the first prenatal visit is best done without the girl's parents, and
they should be encouraged to continue with prenatal visits. Encourage them to eat a sufficient
diet full of nutrients and minerals, teach them how to construct quick, healthy meals, remind
them of the importance of taking vitamins and supplements, assess their level of activity and
participation in sports, suggest alternative activities, and encourage them to breastfeed like the
average pregnant woman.

Pregnant women over the age of 40 may already have adequate information regarding the
importance of early prenatal care and may already have adequate insurance. They should be
assessed for symptoms, income, job, diet, exercise programs, personal habits, and undergo a
thorough physical examination.

Pregnant women with physical and mental challenges are given more ease during pregnancy and
childbirth with the advent of technology.
Prenatal Diagnosis Procedures and Techniques to Obtain a Diagnostic Fetal
Specimen or Tissue: Maternal and Fetal Risks and Benefits

This guideline aims to provide evidence-based guidelines for maternal risk/benefit counselling
for at-risk pregnancies requiring ultrasound-guided prenatal diagnostic procedures. It covers
women considering or requiring an invasive ultrasound-guided procedure for prenatal diagnosis.
The patient population includes pregnant women with an increased risk of fetal genetic
abnormalities due to prenatal screening protocols. The guideline uses published literature from
Medline, PubMed, and the Cochrane Library, as well as unpublished literature from health
technology assessment agencies, clinical practice guideline collections, clinical trial registries,
and medical speciality societies.

Risk/benefit counselling for in utero prenatal diagnosis procedures requires appropriate

patient information with fetal-specific genetic depth of analysis and level of testing
recommended to assist in the informed consent process.

Cost-effectiveness analysis (of medical, personal, and genetic information) are not yet
available for these new prenatal diagnosis scenarios. Patient choice and consent will
require new counselling processes and time commitments.

Prenatal Diagnosis: Screening and Diagnostic Tools

It is recommended by the American Congress of Obstetricians and Gynecologists that diagnostic

testing or aneuploidy screening be made available to all expectant mothers. Patients can choose
from a wide range of screening and testing alternatives according to their gestational age and risk
profile. Traditional serum analyte screening methods, such as quadruple or first-trimester
screening, are among the screening choices. More recently, cell-free DNA has been used.
Amniocentesis and chorionic villus collection are two options for diagnostic testing. Prenatal
counseling is made more challenging for doctors by the multitude of screening and diagnostic
modalities available, which can also be confusing to patients. Adequate comprehension of test
results and alignment of the testing approach with patient objectives are ensured by appropriate
pretest and posttest counseling.

Diagnosis and management of hypertension in pregnancy:

summary of updated NICE guidance
About 10% of expectant mothers have hypertension, which can include pre-existing
hypertension, chronic hypertension initially identified during pregnancy, and pregnancy-related
hypertension (gestational hypertension and pre-eclampsia).
For women who have hypertension during pregnancy, the target blood pressure during the
prenatal period should be 135/85 mm Hg.
Pregnancy-related hypertension is linked to a higher chance of developing hypertension and
cardiovascular diseases in the future. To reduce this risk, women should be given suitable food
and lifestyle recommendations.
About 10% of pregnant women experience hypertension, which is a frequent disease throughout
pregnancy. This comprises pregnant women with gestational hypertension and pre-eclampsia, as
well as women with chronic hypertension, which can be diagnosed either before or during the
first 20 weeks of pregnancy.

Undiagnosed and untreated hypertension can result in negative outcomes for the mother and her
child, such as a higher risk of stroke for the mother, a lower birth weight, and a higher likelihood
that the child would need neonatal critical care.
Definitions of pregnancy-related hypertensive disorders
Serum pressure that is diagnosed as chronic when the patient first seeks maternity care, or before
20 weeks of pregnancy if the patient is already on antihypertensive medication. The aetiology of
it may be primary or secondary.
After 20 weeks of pregnancy, a new case of hypertension without appreciable proteinuria is
known as gestational hypertension.
Pre-eclampsia: After 20 weeks of pregnancy, new-onset hypertension (>140 mm Hg systolic or
>90 mm Hg diastolic) with the coexistence of one or both of the following new-onset conditions:

Proteinuria: (albumin:creatinine ratio: 8 mg/mmol, or ≥1 g/L [2+] on dipstick tests; urine

protein:creatinine ratio: ≥30 mg/mmol)
Additional malfunction of the mother's organs, such as aberrant umbilical artery Doppler
waveform analysis, stillbirth, neurological or haematological problems, or involvement of the
kidneys or liver, or uteroplacental dysfunction