Risk Factors During Pregnancy: A Comprehensive Guide for Midwifery Students, Study notes of Nursing

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MIDWIFERY II

RISK FACTORS OCCURRING

DURING 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

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

Cont’

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

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.

cont’

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

• Respond to the risks o In the most dangerous situations such as compromised foetus, risk response may be dramatic for instance by opting for an emergency caesarean section. o In less risky situations, monitoring may be required. o 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)