The High Risk
Prenatal Client NCM 108
A pregnancy becomes high risk when the mother or fetus has a
significantly increased risk for disability( morbidity) or
death(mortality).
Nursing care for the family experiencing a high risk pregnancy
focuses on the nurse’s independent and collaborative roles.
The independent role of the nurse is to diagnose and treat the
expectant family’s reactions or concerns about the potential risks
inherent to this condition.
The 2nd role and is equally important is collaborative management
of high risk condition with other health team members in a way that
facilitates health and healing. Here, the nurse’s role is to monitor
the high risk condition and implement physician and nurse
prescribed interventions to minimize fetal and maternal
complications.
Assessments that might
categorize a pregnancy
as at risk
1. Existing uterine or cervical anomaly
2. Hx of subfertility, recurrent miscarriages or grand
multiparity
3. Last pregnancy less than 1 year previous
4. Hx of abnormal Pap smear
A. Obstetric 5. Previous premature cervical dilatation, preterm labor,
preterm birth, LBW infant, or cesarean birth
Hx 6. Previous macrosomic infant or multiple gestation
7. Previous abnormal gestational trophoblastic disease
8. Previous ectopic pregnancy or stillborn/neonatal
death
9. Previous infant with neurologic deficit, birth injury or
congenital anomaly
B. Past Illness Hx
1. A chronic disease such as diabetes mellitus, heart disease, renal disease, or
chronic hypertension
2. Emotional disorder or cognitive challenge
3. Family hx of severe inherited disorders
4. Fibroid tumors or previous surgeries on reproductive organs
5. Maternal reproductive tract anomalies or malignancy
6. Seizure disorders
7. Sexually transmitted infections
8. Surgery required during pregnancy
C. Current obstetric status
1. Abnormal fetal surveillance tests
2. Abnormal presentation
3. Premature separation of the placenta or placenta previa
4. Cervical cerclage
5. Limited prenatal care
6. Maternal weight loss or weight gain less than 10 lb by midpregnancy
7. Multiple gestation or hydramnios
8. Gestational hypertension or preeclampsia
9. PROM
10. Rh sensitization
11. STD
D. Psychosocial factors
Attempt or ideation Dangerous Lack of support
of self-injury occupation people
Inadequate finances
Lack of acceptance
inadequate nutrition
of pregnancy
or poor housing
1. Maternal age under 16 years or over
40 years
E. 2. Alcohol use during pregnancy
3. Smoking greater than 10 cigarettes a
Demographic day or living with a person who
smokes this much
factors and 4. Heavy lifting or long periods of
lifestyle standing
5. Recreational drug use
6. Unusual stress
Antepartum Diagnostic
Assessment
A. Laboratory studies
2. Urine 5.
1. CBC 3. ABO and Rho 4. Antibody Rubella/Rubeola
culture Blood typing screen /Varicella screen
6. Venereal
7. Sexually 10. Glucose test
Disease Research 8. Hepatitis B
transmitted 9. HIV screening for gestational
Laboratory virus screen
infections diabetes
(VDRL)
12. Purified Protein 13. Group B 14. Maternal
11. Papnicolaou Derivative test for Streptococcus Serum markers
Test Tuberculosis screening screen
Provides information about leukocyte and erythrocyte levels and
the plasma-to-volume ratio
If leukocyte levels are high, infection may be present. Shifts in
CBC the granular and nongranular leukocyte counts can help
determine whether viral or bacterial infections are present.
If the erythrocyte count is low or hemoglobin and hematocrit
levels are low, anemia may be a problem it should be treated
with nutritive and iron supplements. True anemia of pregnancy
is defined as a hemoglobin level lower than 11 g/dl in the 1st
and 3rd trimesters and lower than 10.5 g/dl in the 2nd trimester.
If renal function is thought to be compromised,
further evaluation may be needed to evaluate
creatinine, protein, and uric acid in the urine and
serum.
Urine culture
If infection is present, treatment can be started
before renal function is impaired and before the
pregnancy is threatened by premature labor.
ABO and Rho Important to know to
(D) Blood
prevent and treat
erythroblastosis fetalis
in the fetus
Typing
Should be done because other
hemolytic incompatibilities may be
present. Clinically significant
Antibody screen disease may develop because of
various blood group antigen shown
in the ABO, Rho(D), Duffy and Kell
systems.
Rubella/ rubeola/varicella screen
Provides information about immunity against these
diseases. If titers indicate lack of immunity, the patient
cannot be vaccinated with the MMR or varicella vaccine
during pregnancy because these vaccines are contain a
live virus and could use fetal anomalies
Venereal disease research laboratory
(VDRL)
A serologic test for syphilis; the presence of this disease affects the
treatment of the mother and the fetus for potential congenital syphilis caused
by maternal infection
Sexually All patients 25 years or younger or at risk for
transmitted STD should be screened for venereal gonococcus
and chlamydia.
infections
Hepatitis B Virus Screen
All pregnant women should be screened for Hepa B surface antigen at
the initial prenatal visit.
Human immunodeficiency Virus (HIV)
Screening
If test results are positive, the woman can be treated with antiviral
medications and combination drug therapies to prevent transmitting HIV to
fetus and lessen the likelihood of developing overt or worsening disease.
All pregnant women , except those
Glucose test for who are at low risk, should be
Gestational screened between 24 and 28 weeks
of gestation for gestational
Diabetes diabetes.
A Pap test should be done at the
time of the 1st prenatal visit. If 3rd
trimester bleeding develops, a Pap
smear test can be repeated to rule
out bleeding caused by carcinoma.
Pap smear
Other diseases such as Monilia and
bacterial vaginitis infections may be
detected on the Pap test.
Purified protein A PPD screen or a Mantoux skin test should
derivative test be performed for all at-risk patients to
identify any old infection or active disease.
for tuberculosis
Group B
All pregnant women should be screened
Streptococcus between 35 to 37 weeks of gestation.
screening
2nd trimester maternal serum markers or the quadruple
marker screen_ which includes unconjugated estriol,
human chorionic gonadotropin, inhibin-A nd alpha
fetoprotein- should be measured between 14 and 22
weeks of gestation.
Maternal Such serum markers may be measured to assess for
developmental defects such as neurotube defects,
serum markers ventral abdominal wall defects, and esophageal and
duodenal atresia.
screen 1st trimester ultrasound nuchal translucency combined
with Hcg and pregnancy-associated plasma protein-A
can be measured between 10 and 13 weeks to screen
for Down Syndrome, Trisomy 18, or major heart
defects.
That in all
things God maybe
glorified
