ObstetricsTier 2Topic

Factors of high-risk pregnancy

Definition

"High-risk pregnancy" = increased likelihood of an adverse maternal or fetal outcome, warranting more intensive antenatal surveillance, specialist input, and a planned birth setting
Risk factors span maternal medical, obstetric history, and current pregnancy domains
No single definition - risk is assessed cumulatively and reassessed throughout pregnancy as new factors emerge

Maternal medical: pre-existing diabetes, chronic hypertension, cardiac/renal disease, autoimmune disease (SLE, APS), morbid obesity, age <17 or >=40, thrombophilia
Obstetric history: previous pre-eclampsia, preterm birth, stillbirth, recurrent miscarriage, previous caesarean, previous macrosomic/growth-restricted infant
Current pregnancy: multiple pregnancy, placenta praevia/accreta, fetal growth restriction, poly/oligohydramnios, abnormal fetal anatomy/genetic screening, gestational diabetes/hypertension

Comprehensive booking history/examination plus ongoing reassessment; combined first trimester screening and morphology scan add further risk information
Risk stratification determines model of care - GP shared care/midwifery-led (low risk) vs obstetric-led/maternal-fetal medicine (high risk)

Individualised surveillance plan: increased visit frequency, serial growth scans, fetal surveillance (CTG, Doppler), planned birth timing/mode, and birth in a facility matched to risk (tertiary centre with NICU for very high risk)
Multidisciplinary input for medical comorbidities (physician, cardiologist, endocrinologist as relevant)

Overlaps heavily with every other high-risk pregnancy topic - VTE, hypertension, diabetes, cardiac disease, recurrent miscarriage

Risk is dynamic, not fixed at booking - re-stratify at every visit as new information (growth, BP, complications) emerges

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