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 the US, overall maternal mortality rate is 6/100,000 deliveries; incidence is 3 to 4 times higher in nonwhite women. The most common causes of death are hemorrhage, preeclampsia, pulmonary embolism, and infection.
Perinatal mortality rate in offspring is 11.5/1000 deliveries: 6.7/1000 are fetal, and 4.8/1000 are neonatal (age < 28 days). The most common causes of death are congenital malformations and preterm delivery.
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 1: High-Risk Pregnancy: Pregnancy Risk Assessment) are assessed systematically because each risk factor present increases overall risk. 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
Last full review/revision January 2009 by Christian M. Briery, MD; John Morrison, MD