Running head: HIGH RISK PREGNANCY
High Risk Pregnancy
Jean M. Collins
American Sentinel University
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HIGH RISK PREGNANCY
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High Risk Pregnancy
If a woman is considered to be likely to have complications during pregnancy, the
pregnancy may be termed high risk. Examples include pregnancies in women with diabetes and
those with high blood pressure. Age-related complications can occur in women such as
teenagers, women who are over the age of 35, or women who have been treated for infertility or
with pregnancies from the use of assisted reproductive technologies. (emedicinehealth, 2013)
Disease Processes
Sometimes a high-risk pregnancy is the result of a medical condition present before
pregnancy. In other cases, a medical condition that develops during pregnancy for either mom or
baby causes a pregnancy to become high risk.
There are special factors that may place women in the high risk pregnancy categories.
These factors include: 1) advanced maternal age- these are mothers that are over the age of 35. 2)
Social factors/ lifestyle choices such as alcohol and drug abuse for these women. 3) Medical
history includes a prior C-section, low birth weight baby or preterm labor/birth. Preterm birth is
before 37 weeks of pregnancy. This might increase the risks for subsequent pregnancies. Other
risk factors include a fetal genetic condition, a family history of genetic conditions, a history of
pregnancy loss or the death of a baby shortly after birth. 4) Maternal underlying conditions.
Chronic conditions such as diabetes, high blood pressure and epilepsy increase pregnancy risks.
Certain blood condition, such as anemia, an infection or an underlying mental health condition
also can increase pregnancy risks.5) Pregnancy complications. These are various complications
that develop during pregnancy that pose risks, such as problems with the uterus, cervix or
placenta, or severe morning sickness (hyperemesis gravidarum) that continues past the first
trimester. Other concerns might include too much amniotic fluid (polyhydramnios) or too little
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amniotic fluid (oligohydramnios), restricted fetal growth or Rh (rhesus) sensitization. This is a
potentially serious condition that can occur when your blood group is Rh negative and your
baby's blood group is Rh positive. 6) Multiple pregnancies. These pregnancy risks are higher for
women carrying twins or higher order multiples. (Mayo Clinic, 2012)
The Scope of the Problems/Issues
For the vast majority of women, pregnancy follows a routine course. Some women,
however, have medical difficulties related to their health or the health of their baby. These
women experience what is called a high-risk pregnancy. High-risk complications occur in only 6
percent to 8 percent of all pregnancies. These complications can be serious and require special
care to ensure the best possible outcome. (University of California San Francisco, n.d.)
Identifying high-risk pregnancies ensures that women who most need medical care receive it in a
specialized center. A high-risk pregnancy diagnosis shouldn't automatically have a negative
view. With early and proper care, 90 to 95 percent of high-risk pregnancies produce healthy and
viable babies. The earlier a problem is detected, the better the chances that both mother and baby
will stay healthy. With the increased advanced development of medical technology, pregnant
women can be carefully monitored for signs and symptoms of high-risk pregnancies and
manages well. (Dangal, 2007)
Why a formal Case Management
Research shows that pregnancy case management programs reduce pregnancy-related
hospitalizations by offering: 1) Risk assessments to identify women at risk for preterm birth or
adverse birth outcomes. 2) Implementation of appropriate interventions before the risk or adverse
condition progresses. 3) OB case management for women with complicated pregnancies to
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ensure optimal birth outcomes. 4) Expanded patient education. 5) Coordination with the
physician and other caregivers. (Healthy Work life, 2012)
Benefits for Case Management
In the absence of risk-reduction efforts, high-risk pregnancies often result in premature
births resulting in costly neonatal intensive care unit stays. Case management programs targeted
to this population can reduce these risks. Common factors for high-risk pregnancy include age
(young or old); maternal weight (i.e., being overweight or underweight); preexisting maternal
health conditions such as high blood pressure, diabetes, or human immunodeficiency virus; and
previous pregnancy-related problems. Case managers can help to reduce the risk of preterm
delivery, but many case management programs do not focus specifically on this population. For
example, case managers saw patients with all types of chronic diseases but were not
automatically assigned to high-risk pregnancies unless the woman had another condition (e.g.,
diabetes) that triggered the use of a case manager. (Agency for Healthcare Research and Quality,
2012)
It is estimated that approximately $25 billion per year is spent for maternal and infant health
care in the United States. Of the $10 billion spent on newborn care alone, over 50% goes towards
the 10% of infants born preterm. Studies have been published documenting that aggressive care
management interventions can achieve lower rates of preterm birth, higher mean birth weights,
fewer nursery days, and less frequent admission to neonatal intensive care units.(Herbelin, 2010)
Why Nurses Should Coordinate Care of Plan
High-risk pregnancy programs lead by nurse case managers is effective in brining high
risk pregnancies to term. One program that is effective is within the home. A high-risk
obstetrical nurse may visit the home of the patient that maybe on bed rest and educate the
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expectant mothers on the services prescribed by their physicians, including preterm labor signs
and symptoms, premature birth facts, and lifestyle issues. Maternal-fetal medicine nurse case
managers within a hospital can provide education about pregnancy, screening, and the birth
process. She/he can also coordinate the care plans designed or recommended by physicians,
organizing care with patients and other providers both within and outside of the hospital. (South
Shore Hospital, 2013) Nurse case managers can provide the patient with any or all information
they may need to make informed decisions related to their problems and plan of care such as: 1)
Physician treatment plan. 2) Disease specific information. 3) Self‐care education. 4) Referrals to
community resources. 5) Medical equipment.
Multidisciplinary Team Approaches
A multidisciplinary team of healthcare professionals can collaborate with any identified
entities such as state supported disease management and medical home vendors, when indicated,
to ensure the participants’ needs are met. This can be accomplished by addressing clinical,
functional, financial, psychosocial, environmental, and support system needs. Team members
include are internal physician, community physician, treating physicians, registered nurses,
pharmacists, and dieticians. Any or all of these team members may participate in case
conferences to coordinate care for individuals who require intense management. Comprehensive,
coordinated care management can help identify and address these risk factors by addressing
housing, nutrition, and tobacco/substance abuse issues; facilitating access to the full range of
needed medical care; and encouraging adherence to evidence-based standards of care. (Agency
for Healthcare Research and Quality, 2013)
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Conclusion
For those with high-risk pregnancies, an experienced case managers can coordinate care
to minimize health risks for mother and baby before and immediately after the child is born.
Case managers coordinate access to hospital and community resources to support the
patient/family's health needs and provide referrals, if needed, to prenatal specialists who provide
specialized care for mother or baby before and after delivery if needed.
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References
Agency for Healthcare Research and Quality. (2012).
http://www.innovations.ahrq.gov/content.aspx?id=1902
Agency for Healthcare Research and Quality. (2013).
http://www.innovations.ahrq.gov/content.aspx?id=3778
Dangal, G. (2007). High-risk Pregnancy [Internet Journal]. The Internet Journal of Gynecology
and Obstetrics, 7(1). http://dx.doi.org/10.5580/28f2
Healthy Worklife. (2012). http://healthyworklifeblog.com/2012/08/30/pregnancy-casemanagement-offers-solution-for-high-risk-costly-medicaid-pregnancies/
Herbelin, M. (2010). Implementing High Risk Pregnancy Care Programs Medical Director
Column. TCS Healthcare Technologies. Retrieved from
http://www.tcshealthcare.com/Newsletter/Winter2010/HighRiskPregnancyCare.htm
Mayo Clinic. (2012). http://www.mayoclinic.com/health/high-risk-pregnancy/MY01923
South Shore Hospital. (2013). http://www.southshorehospital.org/high-risk-pregnancy-programmaternal-fetal-medicine
University of California San Francisco. (n.d.). http://www.ucsfhealth.org/conditions/highrisk_pregnancy/
emedicinehealth. (2013).
http://www.emedicinehealth.com/pregnancy/article_em.htm#pregnancy_overview