3. Every year there are an estimated 200 million pregnancies in the world. Each of these pregnancies is at risk for an adverse outcome for the woman and her infant.. Every minute of every day, a woman dies somewhere as as a result of pregnancy or childbirth In developing countries 99% of women die every year from complications during pregnancy or childbirth.

4. The 2000 National Maternal Mortality Study (NMMS)

5. it is generally thought of as one in which the mother or the developing fetus has a condition that places one or both of them at a higher-risk for complications, either during the pregnancy (antepartum), during delivery (intrapartum), or following the birth (postpartum)

6. Risk Factors:- Risk factors include 1) preexisting maternal disorders 2)problems in previous pregnancies 3)and problems that develop during the pregnancy or during labor and delivery.pregnancy

7. Environmental factors: Living area. Bad sanitation (water, air, food). Present of MCH centers. Culture factors: No access to prenatal care. Wrong concepts (diet, hygienic care, pre married assessment).

8. 1)Illiterate 2) Being a smoker. 3) Exposure to teratogens 4) Using alcohol. 5) Low socioeconomic status.

11. 0-3 low risk 4-7 Moderate risk 8-10 high risk

12. 1.High parity 2.Short birth intervals 3.Twins 4.Preterm births 5.Anemia. 6.Diabetes mellitus 7.Maternal age of 30 years and older 1.Low average age of marriage 2.Illiteracy 3.Lack of prenatal care. 4.Poor health information systems

13. Preventive Measures Reducing High Risk Pregnancy The nursing role in the assurance of maternal and child health can be divided into four phases: The first phase is before the occurrence of pregnancy during examination of the patient seeking pregnancy The second phase is during antenatal care The third phase is that of childbirth care and the fourth phase is puerperium

15. 1)Physical and socio-demographic characteristics. 2) Previous pregnancies. 3) Medical diseases. 4) Present pregnancy or during labor and delivery.

16. Previous stillbirth Previous neonatal death Previous premature infant Previous post-term (over 42 weeks) Pregnancy. Repeated miscarriages. Previous infant over (4.5 kg). Grand multipara.

17. History of preeclampsia. History of eclampsia. Previous cesarean section. History of a fetus with anomalies

18. A pregnant woman with any of the following medical conditions would be considered at risk: Heart disease (class II-IV,( symptomatic( Insulin-dependent diabetes. Chronic hypertension. Moderate to severe kidney disease. Endocrine gland removal sickle cell disease.

19. History of tuberculosis Positive serology for syphilis Pulmonary disease Thyroid disease Family history of diabetes HIV. Epilepsy.

20. Abnormal fetal position Mild to severe preeclampsia Multiple pregnancy Placenta abruption Placenta previa Polyhydramnios or oligiohydramnios Gestational diabetes

21. Vaginal spotting. Bladder infection. Emotional problems. Moderate alcohol use. Smoking more than one pack per day. Infection with parvovirus disease), cytomegalovirus (CMV), toxoplasmosis, rubella.

22. 1.High parity 2.Short birth intervals 3.Twins 4.Preterm births 5.Anemia. 6.Diabetes mellitus 7.Maternal age of 30 years and older 1.Low average age of marriage 2.Illiteracy 3.Lack of prenatal care. 4.Poor health information systems

23. Maternal (medical) disorders:

24. Risk problem Effect on motherEffect on baby Hypertension Preeclampsia to up to 50%. Eclampsia. Abruptioplacenta by 2 to 10%. Preterm labor. Abortion.  Fetal growth retardation.  Congenital anomalies.  Preterm baby.  Intrauterine fetal death. Diabetes Pyelonephritis. Ketoacidosis. PIH. Abortion 1. Macrocosmic baby. 2. Fetal growth retardation. 3. Hypoglycemia. 4. Congenital anomalies. 5. Preterm baby. STDs Bacterial virginities. Gonorrhea. 3. Risk of Genital Chlamydial infection increase. 4.Preterm labor. 5. Premature rupture of the membranes. 1. Fetal death. 2. Congenital malformations. Severe disability. 4. Risk of transmission of HIV is 30 to 50% within 6 m Pyelonephritis 1. Preterm labor. 2. Premature rupture of the membranes. 1.Acute respiratory distress syndrome. 2. Fetal death. 3. Congenital malformations. Genital tract abnormalities Dysfunctional labor. Cesarean section. 3.Uterine fibroids 4.Placental abnormalities Fetal mal presentation., Fetal death. 3. Congenital malformations. Cervical incompetence Preterm delivery., 2. Uterine rupture in vaginal delivery. 3. Poor obstetric outcomes. Preterm baby

25. Physical and social-demographic factors:-

26. Risk problem Effect on mother Effect on baby Maternal age 13% of all pregnancies PIH Eclampsia. Diabetes. Chronic hypertension Preterm labor. Anemia. Dysfunctional labor. Abruptio placenta. Cervical insufficient. Preterm baby. Fetal growth restriction. Stillbirth. Maternal weight Hypertension. Diabetes. Post term pregnancy. Cesarean section Macrocosmic baby Preterm baby. Fetal growth restriction. Stillbirth. Exposure to teratogens Abortion. Infection (herpes simplex, viral hepatitis, rubella, varicella, syphilis, toxoplasmosis, and cytomegalovirus). Fetal malformation. Preterm baby. Stillbirth. Parity (Grandmultipara) Abortion. Preterm labor. Anemia. PIH. Preterm baby. Low birth weight Stillbirth.

27. Getting at least 400 micrograms of folic acid every day if she thinks she could become pregnant, and continuing folic acid when she does get pregnant. Getting proper immunizations. Maintaining a healthy weight and diet, getting regular physical activity, and avoiding smoking, alcohol, or drug use. Starting prenatal care appointments early in pregnancy.

28. Psychosocial Implications of High Risk Pregnancy. The woman who has been diagnosed to be at risk during pregnancy experiences a wide variety of emotions and the normal emotional changes of pregnancy may be intensive. The woman maybe confused about : What is actually happening to her body May fear having an abnormal child May feel a loss of control over the pregnancy because her choices regarding pregnancy and child birth have been limited by her complications. Psychosocial Implications of High Risk Pregnancy. The woman who has been diagnosed to be at risk during pregnancy experiences a wide variety of emotions and the normal emotional changes of pregnancy may be intensive. The woman maybe confused about : What is actually happening to her body May fear having an abnormal child May feel a loss of control over the pregnancy because her choices regarding pregnancy and child birth have been limited by her complications.

29. Pre-pregnancy heath education would include dietary matters, cigarette smoking, alcohol, contraception, pregnancy spacing and the effect of infections such as German measles on pregnancy. The patient is examined for conditions which require treatment before the occurrence of pregnancy, such as severe anemia, tuberculosis, epilepsy and uncontrolled diabetes mellitus.

30. Aim of ANC The antenatal period gives the obstetrician an ideal opportunity to observe, advice, diagnose, treat and correct any abnormalities occurring in the pregnancy

31. Third phase (Labor) Close adherence to conservative obstetric principles are antepartum fetal monitoring, complete asepsis and infection control measures, including antibiotic therapy in cases of prolonged rupture of membranes and making management decisions before or early in labor whenever circumstances permit

32. The mother is still at risk for complications during the immediate and late postpartum periods In order to minimize the risk of immediate postpartum hemorrhage, the obstetrician must have a clear plan of action. The placenta must be carefully examined and the uterus carefully explored to rule out cervical or vaginal laceration or retained products of conception

33. The problem of maternal mortality and high-risk pregnancy continues to be a major preoccupation of health authorities in a number of countries, particularly because the overwhelming majority of these deaths would be preventable if: Consider safe motherhood: a matter of human rights and social justice. Delay childbearing. Consider every pregnancy faces risk. Ensure skilled attendance at delivery. Improve access to maternal health services. Improve the quality of maternal health services. Prevent unplanned pregnancy Address unsafe abortion. Measure progress.