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Overview of High-Risk Pregnancy

By Raul Artal, MD, Professor and Chair, Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine

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There is no formal or universally accepted definition of a high-risk pregnancy. Generally, however, a high-risk pregnancy involves at least one of the following:

  • The woman or baby is more likely to become ill or die than usual.

  • Complications before or after delivery are more likely to occur than usual.

Maternal mortality

Maternal mortality refers to the death of women when death is caused by complications of pregnancy and childbirth.

In the United States, maternal mortality has been increasing. In 2013, 28 women died for every 100,000 deliveries. Women of color are 3 to 4 times more likely to die than white women. The maternal mortality rate is much higher in the United States than in other Western countries (such as Germany, the Netherlands, Poland, Spain, Sweden, Switzerland, and the United Kingdom). However, almost all maternal deaths occur in developing countries. More than half occur in sub-Saharan Africa (including Nigeria), and almost one third occur in South Asia (including India).

Comparing Mortality Ratios for Mothers in Different Countries

In this graph, the maternal mortality ratios in different countries are compared.

Maternal mortality refers to the number of women who die because of problems related to pregnancy and who die during pregnancy or soon after delivery.

The maternal mortality ratio is the number of such deaths for every 100,000 live births (delivery of a living baby).

In 2013, ratios ranged from 1 (Belarus) to 980 (Chad) deaths per 100,000 live births (these countries are not shown below). The maternal mortality ratio is substantially higher in the United States (28 per 100,000 live births) than in most other Western countries.

Data from WHO, UNICEF, UNFPA, The World Bank, and the United Nations Population Division. Trends in Maternal Mortality: 1990 to 2013. Geneva, World Health Organization, 2014.

The most common causes of death in mothers are

Nearly half of maternal deaths could be prevented.

Perinatal mortality

Perinatal mortality refers to the death of fetuses and newborns that occur around the time of delivery. In every 1,000 deliveries, almost 7 fetuses and almost 5 newborns die.

The most common causes of death in fetuses and newborns are

Risk Assessment During Pregnancy

Certain conditions or characteristics, called risk factors, make a pregnancy high risk. As part of routine care during pregnancy, doctors check for these factors to determine the degree of risk for a particular woman and baby and thus to provide better medical care.

Factors that can affect risk in women include

High-risk pregnancies must be closely monitored, and sometimes women are referred to a center that specializes in managing these pregnancies.

The most common reasons for referral before delivery are

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