RISK FACTORS OCCURRING DURING PREGNANCY

➡️ Pregnancy

Objectives

To explain risk factors occurring during pregnancy

To assess the level of risk and handle appropriately

To describe techniques used in handling pregnant woman at risk

To explain options for women with multiple risks

Introduction

Risk factors occurring during pregnancy can be identified through antenatal examination

A woman who have high number of risk factors identified during the antenatal examination or who develops complications during pregnancy should be advised to attend for antenatal care at the hospital (Bennet & Brown1993; Fraser et al 2003)

🔻Risk Factors

-Haemoglobin lower than 10.5g/dl

-Protenuria

- Blood pressure (BP) single diastolic of 110mmHg or two of 90mmHg at least 4hours apart; two systolic of above 160mmHg at least 4hours apart

-Uterus; large or small for gestational age Excess or decreased liquor

-Malpresentation

-Foetal movement pattern significantly reduced or changed

-Any vaginal, cervical or uterine bleeding

- Premature labour

- Vaginal infection

- Sociological or psychological factors

-Head not engaged in primigravida woman by 38 weeks

📶 High Risk Factors

- Sudden gush of fluid (premature rupture of membranes)

-Vaginal bleeding (possible placenta praevia, abruption placentae, lesions of the cervix or vagina, show)

- Abdominal pain (premature labour or abruption placentae)

-Temperature above 38 Centigrade

- Blurring of vision or double vision (serious pre-eclampsia)

- Persistent vomiting (hyperemesis gravidarum)

- Severe headache (hypertension or pre-eclampsia)

- Epigastric pain (serious pre-eclampsia)

-Dysuria and or low abdominal pains (urinary infection)

-Decreased foetal movements

Assessment of Risk Factors

Assessment of risk factors is done during the antenatal clinic through assessment and examinations.

Techniques in Handling Pregnant Woman at Risk.

Identify the risks

-Risks are those factors that may affect our prospects of achieving an optimal result.

-These can be identified during early stage of the pregnancy through history taking, physical examination and screening/laboratory tests.

Determine the risk

-Those factors that generate the greatest risk need to be assessed in order to gain some indication of how severe the risks are

- The risk of an outcome is generally considered to be the product of the probability of that outcome multiplied by the severity of that outcome if it was to occur.

-Thus life-threatening outcomes must be kept at very low levels of probability to be acceptable

Respond to the risks

-In the most dangerous situations such as compromised foetus, risk response may be dramatic for instance by opting for an emergency caesarean section.

-In less risky situations, monitoring may be required

-This situation requires patient/client’s involvement in decision making to obtain consent and to make sure that patients’ preferences are respected.

Options for Women with Few

or Multiple Risks.

Shared care between midwife and general practitioner (GP); delivery may take place in the dispensary or health centre.

Care by an independent midwife; delivery may take place in the dispensary or health centre

Shared care between midwife and general practitioner with key visits to hospital clinic; delivery often takes place in hospital.

Shared care between a hospital midwife and senior obstetrician, delivery should be in the hospital (Myles, 1999)