High-Risk Pregnancy Identification

Definition & Significance - Spotting Trouble Early

• High-Risk Pregnancy (HRP): Condition where mother, fetus, or neonate faces ↑ chance of morbidity/mortality pre-, intra-, or postpartum.
• Primary Goal: Early identification of potential risks to mother or fetus.
• Significance:
  • Enables timely, targeted interventions & specialized care.
  • Aims to ↓ maternal & perinatal adverse outcomes.
  • Guides appropriate level of surveillance & resource allocation.

⭐ Early and accurate identification of high-risk pregnancies is a cornerstone of effective antenatal care, significantly impacting feto-maternal prognosis and reducing preventable complications an Indian context priority for MMR & IMR reduction goals

Maternal Risk Factors - Mom's Health Check

• Age: <18 yrs or >35 yrs (AMA).
• Parity: Nulliparity; Grand multiparity (>5 births).
• Previous Obstetric Hx:
  • Recurrent abortions (≥3).
  • Stillbirth/NND Hx.
  • Prior baby: anomaly, IUGR, macrosomia (>4.5kg).
  • Hx Preterm birth.
  • Uterine surgery (C-section, myomectomy).
  • Hx PET/Eclampsia, GDM.
  • Rh isoimmunization.
• Medical Co-morbidities:
  • Chronic HTN (BP ≥ 140/90 mmHg).
  • Pre-gestational DM.
  • Cardiac disease (NYHA III/IV).
  • Renal/Thyroid disorders.
  • Epilepsy (on AEDs).
  • Autoimmune (SLE, APS).
  • Severe Anemia (Hb < 7 g/dL).
  • Infections (HIV, HBV, HCV, Syphilis, TB).
• Other Maternal Factors:
  • BMI <18.5 or ≥30.
  • Short stature (<145 cm).
  • Substance use (smoking, alcohol, drugs).
  • Poor/Late ANC.

⭐ AMA (>35 yrs) significantly ↑ risk of chromosomal abnormalities (e.g., Down syndrome), GDM, and pre-eclampsia.

Fetal & Placental Risk Factors - Baby's Support System

• Fetal Factors:
  • Multiple gestation: ↑ risk PTL, IUGR, pre-eclampsia, cord accidents.
  • Chromosomal abnormalities (Aneuploidies: Trisomy 21, 18, 13).
  • Congenital anomalies (Structural: NTDs, cardiac, diaphragmatic hernia).
  • Intrauterine Growth Restriction (IUGR).
  • Fetal infections (TORCH).
  • Rh Isoimmunization: Risk of fetal anemia, hydrops.
  • Known fetal genetic condition.
• Placental Factors:
  • Placenta previa: Implantation over/near cervix; painless APH.
  • Abruptio placentae: Premature separation; painful APH, uterine tenderness; DIC risk.
  • Placental insufficiency: Leads to IUGR, oligohydramnios, fetal hypoxia.
  • Abnormal cord insertion (Velamentous, Vasa previa).
  • Single Umbilical Artery (SUA): Marker for other anomalies.
  • Molar pregnancy (GTD).
  • Placenta accreta spectrum.

⭐ Vasa previa: Fetal vessels unprotected over internal os. Rupture of membranes (ROM) can cause rapid fetal exsanguination; high mortality (~60% if undiagnosed).

Screening & Assessment - The Detective Toolkit

Identifies maternal, fetal, placental risks via systematic screening.

• History Taking:
  • Maternal age (<18y, >35y), Past Obstetric Hx (IUGR, IUD, RPL, Preterm, anomalies), medical Hx (DM, HTN, cardiac, thyroid), family Hx (genetic disorders).
• Clinical Examination:
  • BMI (<18.5, >25 kg/m²), Blood Pressure (≥140/90 mmHg), systemic exam, obstetric exam (fundal height, FHS).
• Key Investigations:
  • Baseline: CBC, Blood group & Rh, Urine R/M, GCT/GTT (24-28 wks), HIV, HBsAg, VDRL, TSH.
  • Genetic Screening: NT scan + Dual marker (11-13+6 wks), Quadruple test (15-20 wks), NIPT (as indicated).
  • Fetal Wellbeing: Anomaly scan (TIFFA, 18-20 wks), Doppler USG (growth restriction, preeclampsia).

⭐ In India, universal GDM screening with 75g OGTT (DIPSI criteria): any one value - Fasting ≥92, 1hr ≥180, 2hr ≥153 mg/dL indicates GDM.

High‑Yield Points - ⚡ Biggest Takeaways

• Previous adverse outcomes (IUGR, IUD, preterm, preeclampsia) are major red flags.
• Extreme maternal age (<18 or >35 years) significantly increases risk.
• Key maternal medical disorders (diabetes, hypertension, cardiac, renal, thyroid) define high risk.
• Current pregnancy complications (multiple gestation, APH, GDM, PIH) demand vigilance.
• Significant infections (TORCH, HIV, syphilis) and substance use are critical.
• Inadequate antenatal care or low socioeconomic status are important identifiers_