Although as of 2004 there was no formal or universally accepted definition of a "high-risk" pregnancy, it is generally thought of as one in which the mother or the developing fetus has a condition that places one or both of them at a higher-than-normal-risk for complications, either during the pregnancy (antepartum), during delivery (intrapartum), or following the birth (postpartum).
Certain conditions, called risk factors, make a pregnancy high risk. Maternal conditions can be identified with preconception counseling and from the maternal history. Maternal physical and social characteristics that can contribute to a high-risk pregnancy include:
age younger than 15 years and older than 35 years
pre-pregnancy weight under 100 lbs (45 kg) or obesity
For women who do not have health insurance, obtaining early prenatal care is extremely difficult, and these same women are often from a socioeconomic level that prevents adequate or appropriate nutritional intake. There is a scoring system that can be used by healthcare professionals to determine the degree of risk for a pregnant woman, but it is difficult to rate risk by degrees. Nevertheless, identification of a high-risk pregnancy helps to ensure that those women who need the most care receive it.
One of the initial factors to consider when evaluating risk is the obstetrical history. If this is not the woman's first pregnancy, outcomes of her previous pregnancies are of importance in relation to the outcome of this one. An obstetrical history with any of the following conditions would be considered high risk:
If prenatal testing indicates the baby has a serious congenital anomaly as a heart defect or spinal cord defect, the mother may need additional testing to determine the extent of the problem. Certain maternal or fetal problems may require the physician to deliver a baby early or to choose a surgical delivery (cesarean section) rather than a vaginal delivery.
Most women will see one healthcare provider during pregnancy, either an obstetrician, a midwife, or a nurse practitioner. Women who have a medical problem may need to see a medical specialist as well. Women diagnosed with a high-risk pregnancy should seek the care of an expert in the field of high-risk obstetrics, called a perinatologist. Perinatologists have additional training beyond the education required for an obstetrician. They care for women who have pre-existing medical problems, women who develop complications during pregnancy, and women whose fetus has problems.
Linda K. Bennington MSN, CNS, Thomson Gale, Gale, Detroit,