OBSTETRICS

Identification of High Risk Pregnancy

Lecturer: Dr. Mercado | August 7, 2017
Transcribed by: AAG l JBG l ECL l ABL l RAM

OUTLINE o IUGR
1. Incidence of Fetal Death o Big babies
2. Risk Factors o Premature labor
i. Age
ii. Maternal Height
o
iii. Maternal Weight
iv. Social Factors
v. Obstetrical History
vi. Premature rupture of membrane
vii. IUGR
viii. Postterm Pregnancy
ix. Preterm Pregnancy
x. Fetal Macrosomia
xi. Multiple Pregnancy
xii. Hydramnions and Oligohydramnions
xiii. UTI
xiv. DM
xv. Thyroid Disorders
3. Indications for antepartum fetal monitoring
4. Obstetrical conditions and management that might be
influenced by antepartum testing
5. Aspects Of Fetal Condition That Might Be Predicted By
Antepartum Testing
6. Core of any Obstetricians competency

Social Factors
INCIDENCE OF FETAL DEATH
- Smoking - birth defects, low birthweight, low folate, Vit C
- 30% asphyxia secondary to hCG and prolonged
and carotenoids
pregnancy
- Alcohol intake - still birth, birth defects, low birthweight
- 30% maternal complications secondary to abruptio
placenta, hypertension, preeclampsia, DM
- Drugs
- 15% congenital malformation and chromosomal Tetracycline : yellowing discoloration
Chloramphenicol : gray baby syndrome, cardiac
abnormalities
failure
- 5% infections Streptomycin: affect auditory nerve causing
- 20% unknown cause congenital deafness

RISK FACTORS
Maternal Factors
Age
- <18 years old example: pre eclampsia because of
early exposure to trophoblast
- >30 years old - nullipara
- >35 years old - multipara

Maternal Height
- 60 inches or 153cm or less

Maternal Weight
- Obesity and abnormal BMI
Obstetrical History
- Complications: - Multigravid
o GDM, hypertension, preeclampsia - GDM, hypertension, malnourish, iron deficiency
o Shoulder dystocia d/t macrosomia - Postpartum hemorrhage
1

Premature rupture of membrane (PROM)
3 clinical significance:
1. If the presenting part is not fixed in the pelvis; the
possibility of cord prolapse and subsequent
compression is increased
2. Labor is quite likely to occur
3. There is the possibly of intrauterine infection
- risk: history of PROM
- cause of PROM: GBS (Group B Strep)
- complication: chorioamionitis
Intrauterine Fetal Growth Restriction
Maternal risk factors for IUGR
Social History poor weight gain in pregnancy,
smoking, poor socioeconomic history
Obstetrical History previous IUGR, repeated
miscarriage, still births and neonatal deaths
Medical History
Screening methods in identifying IUGR
- Abdominal palpation, fundic height, amniotic fluid
estimate
- Ultrasonography: BPD, femur length, head
circumference, mean abdominal diameter,
abdominal circumference
- Doppler velocimetry
Postterm Pregnancy
- Dysmaturity actual loss of weight in utero with
evidence of reduced subcutaneous tissue scaling
and parchment-like skin.
- At risk for fetal death due to meconium aspiration
syndrome
- Complications:
1. Sharp rise in fetal and neonatal mortality
after 42 weeks
2. Fetal injury from fetopelvic disproportion
3. Asphyxial damage from fetal distress
- Postdatism beyond 40 week, time for
antepartum surveillance
- Postterm beyond 42 weeks
Others:
Preterm Pregnancy
Fetal Macrosomia
Multiple Pregnancy
Hydramnions and Oligohydramnions
UTI
DM
Thyroid Disorders
OBSTETRICS Identification of High Risk Pregnancy
INDICATIONS FOR ANTEPARTUM FETAL MONITORING
1. High risk for uteroplacental insufficiency
- prolonged pregnancy
- DM
- hypertension
- previous stillbirth
- suspected IUGR
- Advance maternal age
- multiple gestation with discordant growth
- antiphospholipid syndrome
2. Other test suggest fetal compromise
- suspected IUGR
- decreased fetal movement
- oligohydramnions
3. Routine antepartum surveillance
OBSTETRICAL CONDITIONS AND MANAGEMENT THAT
MIGHT BE INFLUENCED BY ANTEPARTUM TESTING
1. Preterm delivery
2. Route of delivery
3. Bed rest
4. Observation
5. Drug therapy
6. Operative intervention in labor
7. Neonatal intensive care
8. Termination of Pregnancy for a congenital anomaly
ASPECTS OF FETAL CONDITION THAT MIGHT BE PREDICTED
BY ANTEPARTUM TESTING
1. Prenatal death bec of abnormalities in umbilical
artery doppler velocimetry.
2. IUGR
In doppler velocimetry, if you check:
Uterine artery : checking for pre eclampsia
Umbilical artery: checking for IUGR
3. Non-reassuring fetal status (intrapartum)
4. Neonatal asphyxia
5. Postnatal monitor and intellectual impairment
6. Premature delivery
7. Congenital abnormalities
8. Need for specific therapy
CORE OF ANY OBSTETRICIANS COMPENTENCY:
Proficiency in counselling pregnant patients on active
health promotion and disease prevention
Education and individual commitment to preventive
health care including dietary behaviour change of each
reproductive age woman and her partner is essential in
ensuring a good pregnancy outcome