Assessment & Screening of High Risk Pregnancy

ASSESSMENT & SCREENING OF
HIGH RISK PREGNANCY
by – Shreya Biswas
Bsc Nursing 4th year
West bank College of Nursing
What is high risk pregnancy?
 Which is the condition for high risk

pregnancy?
a. Diabetes
b. Multiple gestation
c. preterm birth
d. above all
Ans -
 d. Above all.
• INTRODUCTION :
All pregnancies are at partially at high risk . About

20-30 % cases are in this categories . Majority of
fetal death occurs before the onset of labour due
to cronic asphyxia (30%) , congenital
malformation (15%)and with superimposed
complications (30%) and 20% are still birth .
• DEFINITION :
High risk pregnancy is defined where the mother ,

fetus or newborn is may possibly be at incresed
risk of morbidity before , during and after
delivery by some factors .
• FACTORS :
Factors for increased risk :

 Maternal: diabetes , hypertension , endocrine
(thyroid) , preterm labour .
 Fetal : Structural anomalies , chromosomal
abnormalities , genetic issue , multiple gestation
or infection .
 Maternal-fetal : preterm birth , premature
rupture of membrane , cervical insufficiency , still
birth , intrauterine growth reterdation etc .
• examination & screening:
 Examination: risk assessment starts with a

good history taking and examination ;
investigation and organized for management .
 History:
Maternal age : extreme maternal age increasing
the risk of maternal and fetal morbidity .
Adolecents increased risk of preeclampsia ,IUGR;
women with increasing age are at risk of
placenta previa , placenta accreta etc .
Type of conception:
In case of assisted reproductive technology (ART)
increasing risks are :
Preterm birth, multifetal gestation , low birth weight,
congenital anomalies , increased mortality .
Reproductive History
Past Medical & Surgical History
Family History
• Physical examination :
 General physical examination :

 Build: (thin / avarage / obese )
 Nutrition: ( good / avarage / poor )
 Hight: short structure associated with small
pelvis (it’s 4feet 7inch in Indian taken as the low
avarage hight )
 Weight
 Pallor
 Jaundice
Toungue , teeth , gums and tonsils
 Neck
 Edema of Legs
 Puls
 Blood pressure
 Systemic examination : heart , lungs , GI system , and
spleen.
 Breast: check for nipples ( crackles , depressed) & Skin
condition of areola ; purpose is todetect the abnormality to
avoid the difficulty during breast feeding .
 Obstetrical examination : Check for any abdominal muscles
or scar incisionor present of herniation , check for fundal
hight just above the symphysis pubis.
• Investigation :
 Blood :heamoglobin,hematocrit,ABO,RH
typing , blood glucose , VDRL are done .
 Serology (antibody) screening is done
 Urine : protein , suger , and pus cells
 Cervical cytology study : by pap smear or
liquid based cytology (LBC) is a routine unless
done before .
 RISK SCORE CRITERIA :
• INTERPRETATION OF SCORE:
The points are added up to give a total score and

decisions taken are as follows :
 high risk – 5 points / more
 high risk referral recommended – 3-4 points
 usual risk – 0-2 points
• Screening:
 First Trimester : nuchal transluency (NT) is measured

between 11^0/7 and 13^6/7 weeks , combined with
maternal serum free B-GCG and pregnancy associated
plasma protien –A . Increased NT is associated with
higher risk of cardiac defects diaphragmatic hernia ,
fetal skeletal dysplasia and other genetic syndromes.
Second trimester screening :

“Quad screen” can defect fetus with NTD and certain
chromosomal abnormalities (trisomy 21) . Integrated
aneuploidy screening is suggested
 cell free DNA for aneuploidy screening – for
trisomy 21 , 18 and 13 detection rate of >98% with
faulse –posetive rate 0.2 – 0.5 %
 screening for gestational diabetes
 assessment of fetal wellbeing; ultrasonography is
commonly used .
 Invesive test for prenatal diagnosis are –
 chorionic villus sampling
 Amniocentesis
 Fetal blood sampling
 Antenatal fetal wellbeing:
 fetal movement assessment
 Nonstress test
-biophysical profile ( bpp)
- growth profile
- dropplar studies
CONCLUSION:
The current study found that almost one-fifth of
the pregnant women in rural area high-risk
pregnancy . Unfavorable obstetric and neonatal
outcomes are common among high riskcases .
So that assessment and screening is important.

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ASSESSMENT & SCREENING OF

HIGH RISK PREGNANCY

 Which is the condition for high risk

All pregnancies are at partially at high risk . About

High risk pregnancy is defined where the mother ,

Factors for increased risk :

 Examination: risk assessment starts with a

Past Medical & Surgical History

 General physical examination :

The points are added up to give a total score and

 First Trimester : nuchal transluency (NT) is measured

Second trimester screening :

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