tailieunhanh - HIGH-RISK PREGNANCY

Although pregnancy can be classified as a normal physiologic condition, it is fraught with considerable risk to both mother and offspring. Fortunately, most of the risk occurs to a minority of patients. Thus, it is prudent to identify those at risk and attempt to prevent the morbidity and mortality. Some factors contributing to risk are quite obvious, but others are very subtle. Thus, care must be taken in definitions, screening programs, and application of the tools available for diagnosis and treatment. The following is but one of the ways to approach this multifaceted set of circumstances. . | HIGH-RISK PREGNANCY Although pregnancy can be classified as a normal physiologic condition it is fraught with considerable risk to both mother and offspring. Fortunately most of the risk occurs to a minority of patients. Thus it is prudent to identify those at risk and attempt to prevent the morbidity and mortality. Some factors contributing to risk are quite obvious but others are very subtle. Thus care must be taken in definitions screening programs and application of the tools available for diagnosis and treatment. The following is but one of the ways to approach this multifaceted set of circumstances. DEFINITION INCIDENCE AND IMPORTANCE A high-risk pregnancy is one in which the mother or perinate is or will be in jeopardy death or complications during gestation or in the puerperium neonatal interval. Estimates of the incidence of high-risk pregnancy vary widely depending mainly on the criteria used for definition and the accuracy of the data collection. Nevertheless by most standards 20 of established pregnancies in the United States are at some risk and 5 are at high risk. About half can be identified antenatally and another quarter during labor Table 7-1 . For example the majority of perinatal deaths are associated with prematurity or congenital anomalies. If these two conditions are excluded 60 of fetal and 50 of neonatal deaths are associated with only five obstetric complications breech presentation premature separation of the placenta preeclampsia-eclampsia multiple pregnancy and urinary tract infection. Certain less common complications . cord prolapse also cause an inordinately high proportion or perinatal losses. Of course a low-risk pregnancy not endangered by present or foreseeable complications can become high risk at any time. The early identification of risk factors is vital for both avoidance of serious problems and proper treatment of complications 199 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. 200 BENSON PERNOLL S