Case 1: A woman arrives at the clinic seeking confirmation that she is pregnant for the first
time. The following information is obtained: She is 37 years old with a body mass index (BMI) of
17.5. She admits to having used cocaine “several times” during the past year and drinks alcohol
occasionally. Her blood pressure (BP) is 108/70 mmHg, her pulse rate is 72beats/min, and her
respiratory rate is 16 cpm. The family history is positive for diabetes mellitus and cancer. Her
sister recently gave birth to an infant with neural tube defect (NTD).
1. What is high risk pregnancy?
A high-risk pregnancy is one that threatens the health or life of the mother or her
fetus. It often requires specialized care from specially trained providers. Some
pregnancies become high risk as they progress, while some women are at
increased risk for complications even before they get pregnant for a variety of
reasons.
2. Based on the given case, identify the factors that put the patient at risks and explain how?
The woman’s family history of an NTD, her low BMI, and her drug and alcohol
use abuse are high risk factors of pregnancy. The woman’s BP is normal, and
her age does not put her at risk. Her BMI is low and may indicate poor nutritional
status, which is a high risk.
3. Why there’s a need to Identify or detect women with high risk factors?
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 you or your baby
causes a pregnancy to become high risk.
Specific factors that might contribute to a high-risk pregnancy include:
Advanced maternal age. Pregnancy risks are higher for mothers older than age 35.
Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put
a pregnancy at risk.
Maternal health problems. High blood pressure, obesity, diabetes, epilepsy, thyroid
disease, heart or blood disorders, poorly controlled asthma, and infections can increase
pregnancy risks.
Pregnancy complications. Various complications that develop during pregnancy can
pose risks. Examples include an abnormal placenta position, fetal growth less than the
10th percentile for gestational age (fetal growth restriction) and rhesus (Rh)
sensitization — a potentially serious condition that can occur when your blood group is
Rh negative and your baby's blood group is Rh positive.
Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher
order multiples.
Pregnancy history. A history of pregnancy-related hypertension disorders, such as
preeclampsia, increases your risk of having this diagnosis during your next pregnancy.
If you gave birth prematurely in your last pregnancy or you've had multiple premature
births, you're at increased risk of an early delivery in your next pregnancy. Talk to your
health care provider about your complete obstetric history.
4. Enumerate diagnostic tests for high risk pregnancy (Invasive/ non –invasive)
Diagnostic tests used during pregnancy can be invasive or non-invasive and include:
chorionic villus sampling.
amniocentesis.
ultrasound.
Case 2: A healthy 29-year-old woman who has been trying to conceive presents with
vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left
lower quadrant for the past 3 days. Her last menstrual period was 6 weeks and 2 days
before presentation. She has had a spontaneous vaginal delivery and an anembryonic
gestation treated by dilation and curettage. How should this patient be evaluated and
treated?
1. What is the case presented?
Ectopic pregnancy
2. What are symptoms of the above case?
You may not notice any symptoms at first. However, some
women who have an ectopic pregnancy have the usual early
signs or symptoms of pregnancy — a missed period, breast
tenderness and nausea. If you take a pregnancy test, the result
will be positive. Still, an ectopic pregnancy can't continue as
normal. As the fertilized egg grows in the improper place, signs
and symptoms become more noticeable.
3. What are possible causes of the given case?
The cause of an ectopic pregnancy isn’t always clear. In some cases, the following
conditions have been linked with an ectopic pregnancy:
inflammation and scarring of the fallopian tubes from a previous medical condition,
infection, or surgery
hormonal factors
genetic abnormalities
birth defects
medical conditions that affect the shape and condition of the fallopian tubes and
reproductive organs
