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Overview of High-Risk Pregnancy
In a high-risk (at-risk) pregnancy, the mother, fetus, or neonate is at increased risk of morbidity or mortality before or after delivery.
In 2013, overall maternal mortality rate in the US was 28/100,000 deliveries; incidence is 3 to 4 times higher in nonwhite women. The maternal mortality rate is substantially higher in the US than in other Western countries (eg, Germany, Netherlands, Poland, Spain, Sweden, Switzerland, United Kingdom).
Maternal Mortality Ratios in Selected Countries
The most common causes of maternal death are
Nearly half of maternal deaths are preventable.
Perinatal mortality rate in offspring in the US is about 6 to 7/1000 deliveries; deaths are divided about equally between those during the late fetal period (gestational age > 28 wk) and those during the early neonatal period (< 7 days after birth).
The most common causes of perinatal death are
Risk assessment is part of routine prenatal care. Risk is also assessed during or shortly after labor and at any time that events may modify risk status. Risk factors (see Table: Risk Factors for Complications During Pregnancy) are assessed systematically because each risk factor present increases overall risk.
Several pregnancy monitoring and risk assessment systems are available. The most widely used system is the Pregnancy Assessment Monitoring System ( PRAMS ), which is a project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS provides information for state health departments to use to improve the health of mothers and infants. PRAMS also enables the CDC and states to monitor changes in health indicators (eg, unintended pregnancy, prenatal care, breastfeeding, smoking, drinking, infant health).
High-risk pregnancies require close monitoring and sometimes referral to a perinatal center. When referral is needed, transfer before rather than after delivery results in lower neonatal morbidity and mortality rates.
The most common reasons for referral before delivery are
Pregnancy Risk Assessment
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