HIGH RISK PREGNANCY of pediatrics age group ppt.pptx

high risk pregnancy

1. HIGH RISK PREGNANCY

2. OVERVIEW In a high-risk pregnancy, the mother, fetus, or neonate is at increased risk of morbidity or mortality before of after delivery Pregnancy places additional physical and emotional stress on a women’s body Health problems that occur before a women becomes pregnant pr during pregnancy may also increase the likelihood for a high risk pregnancy

3. CAUSES: Hypertension leading to pre-eclampsia Diabetes causing gestational diabetes Recurrent pregnancy loss Late pregnancy Assisted reproductive therapy Obesity Nutritional deficiency Autoimmune disease Placental problems TYPICAL AGE OF WOMEN WHO FALL UNDER HIGH RISK OF PREGANCIES ARE 30-38

4. Complications can occur during pregnancy and affect the health and survival of the mother and the fetus Every pregnant women must receive at least 4 checkups during pregnancy ( Govt. of India) Registration and 1 st checkup within 12 weeks, 14-26 weeks, 28-34 weeks and 36 weeks to term Proper history should be elicited and completed ,general physical, systemic and abdominal examinations performed during each ANC visit HIGH RISK FACTORS OF PREGNACY AND THEIR MANAGEMENT AT AN ANC CLINIC

5. FIRST ANTENATAL VISIT INVESTIGATIONS DONE ABO/Rh status Complete blood count + hemoglobin Urine routine microscopy HIV HbsAg testing VDRL test/RPR Diabetes testing

6. Td (Tetanus + diptheria toxoid) vaccine : Td-1 at 1 st visit Td-2 after 4 weeks If pregnant female received complete Td vaccination within last 3 years : only Td booster in current pregnancy TdaP (Tetanus + diptheria + acellular pertussis) vaccine: Single shot between 27-32 weeks (ACOG guidelines) VACCINATION

7. HIGH RISK FACTORS : Extremes of age : <20 yrs or >35 yrs HIV + ve / HbsAg + ve Severe systemic illness Severe anemia (Hb <7g/dl) Hypothyroidism Multi-fetal pregnancy Placenta previa Malpresentation Bad obstetric history Pre-eclampsia/ gestational DM Previous h/o C-section Any pregnancy complications IDENTIFICATION OF HIGH RISK PREGNANCY:

8. COLOUR CODING OF ANTENATAL CARD COLOUR ON CARD RISK FACTORS GREEN NO RISK FACTOR RED HIGH RISK FACTOR PRESENT BLUE PREGNANCY INDUCED HTN(PIH) YELLOW COMORBID CONDITIONS: GDM/HPOTHYROIDISM

9. As per PRADHAN MANTRI SURAKSHIT MATRITVA ABHIYAN: GREEN : No risk factor Only 2 colours RED : HRF+ 3 additional antenatal visits advised

10. ALERT SIGNS & SYMPTOMS : Patient to be advised to visit hospital if she has or develops : Fever > 38*c for > 24hrs Persistent vomiting Headache/blurring of vision Generalised edema/puffiness of face Discharge/bleeding PV Abdominal pain fetal movements Breathlessness at rest

11. FOLIC ACID SUPPLEMENTATION: TO PREVENT NTD 400mcg/day (prophylactic dose) Given to all pregnant females TO PREVENT RECURRENCE OF NTD 4mg/day (therapeutic dose) Given to females with previous h/o NTD RDA in pregnancy : 500mcg/day

12. 4 th month onwards: IRON + FOLIC ACID supplementation(IFA) as per ANEMIA MUKT BHARAT PROGRAMME 60mg elemental iron + 500mcg folic acid : RED colored tablet 1 tablet/day to prevent anemia : To pregnant females without anemia 2 tablets/day given to treat anemia : To pregnant females with anemia