Guia completo de Pré-Natal de Alto Risco (PNAR): cuidados essenciais para melhores condutas e resultados
- Carlos Felipe
- 30 de out. de 2024
- 24 min de leitura
Atualizado: 11 de nov. de 2024
Uma gravidez de alto risco é aquela que apresenta uma maior probabilidade de complicações para a mãe, o feto ou ambos. Diversos fatores podem contribuir para essa classificação, incluindo condições médicas pré-existentes, idade materna e complicações que surgem durante a gravidez.
Gestações de alto risco exigem um acompanhamento mais rigoroso e estratégias de cuidado específicas para garantir melhores resultados para a mãe e o bebê. O gerenciamento dessas gestações através do pré-natal de alto risco é essencial, pois podem estar associadas a complicações graves, como parto prematuro, baixo ou alto peso ao nascer e condições como a pré-eclâmpsia, que oferecem riscos significativos para a saúde materna e fetal.
A relevância do tema é crescente, especialmente a partir do aumento progressivo da idade materna (principalmente a partir de 2008, com a mudança das regulações e autorizações para FIV - Fertilização in Vitro) e o aumento da prevalência de condições como diabetes e hipertensão entre gestantes.
À medida que os sistemas de saúde se adaptam a essas mudanças demográficas, entender os detalhes das gestações de alto risco torna-se fundamental para profissionais de saúde e futuros pais.
Nesses casos, o cuidado pré-natal envolve avaliações frequentes, orientações nutricionais e apoio emocional para atender às necessidades complexas dessas pacientes.
Causas da gestação de alto risco
Uma gestação de alto risco é caracterizada por um aumento da probabilidade de complicações que podem afetar tanto a mãe quanto o feto. Vários fatores podem contribuir para que uma gravidez seja classificada como de alto risco, incluindo condições médicas prévias, idade materna e complicações que surgem durante a gravidez.
Condições médicas prévias
Mulheres que engravidam com certas condições médicas frequentemente se enquadram na categoria de alto risco. Condições comuns incluem diabetes, doenças cardíacas, hipertensão, obesidade e doenças autoimunes.
A presença dessas condições pode complicar tanto a gravidez quanto o parto, aumentando o risco de complicações, como pré-eclâmpsia ou diabetes gestacional. Além disso, o histórico de abortos espontâneos ou complicações em gestações anteriores pode elevar o nível de risco.
Idade materna
A idade da mãe é um fator importante na determinação do risco gestacional. Mulheres com menos de 17 ou mais de 35 anos têm mais chances de enfrentar complicações durante a gravidez e o parto.
O risco de aborto espontâneo e anormalidades genéticas, como distúrbios cromossômicos, aumenta significativamente após os 40 anos. Em contrapartida, mães jovens, especialmente aquelas entre 10 e 19 anos, também estão em risco maior de desenvolver condições como eclâmpsia e infecções.
Complicações durante a gravidez
Algumas complicações podem se desenvolver ao longo da gravidez, elevando o nível de risco. Entre elas estão a gestação múltipla (gêmeos, trigêmeos etc.), diabetes gestacional e hipertensão induzida pela gravidez (como a pré-eclâmpsia).
A presença de múltiplos fetos aumenta a chance de parto prematuro, complicações no parto e outros problemas de saúde, tanto para a mãe quanto para os bebês.
Fatores ambientais e de estilo de vida
Fatores ambientais também podem aumentar o risco de complicações durante a gravidez. A exposição a altas temperaturas, radiação ou grandes altitudes pode prejudicar o desenvolvimento fetal.
Além disso, escolhas de estilo de vida, como o consumo de tabaco e álcool, bem como o uso de outras substâncias, estão associados a maiores riscos e podem levar a complicações graves para a mãe e o bebê.
Cuidados pré-natais essenciais
O cuidado pré-natal é essencial para gerenciar uma gravidez de alto risco, pois foca no monitoramento da saúde da mãe e do feto para prevenir possíveis complicações. A estratégia de cuidado inclui avaliações regulares (Definidos pelo Ministério da Saúde), recomendações nutricionais e suporte multidisciplinar adaptado às necessidades específicas de cada paciente.
Apoio psicológico
O bem-estar emocional das gestantes é igualmente importante na gestão de uma gravidez de alto risco. A ansiedade relacionada à classificação de alto risco pode gerar sentimentos de medo e culpa, impactando tanto a saúde mental quanto física.
Os profissionais de saúde devem incentivar discussões sobre essas emoções e promover recursos de saúde mental, como terapia ou grupos de apoio, para ajudar as pacientes a lidar de forma saudável com suas experiências.
Orientação nutricional
A nutrição adequada durante a gravidez é essencial para prevenir complicações, como anemia, que pode ocorrer devido à deficiência de ferro, folato e vitamina B12.
Gestantes são incentivadas a consumir alimentos ricos em ferro, incluindo carnes, feijões e folhas verdes, além de considerar a suplementação de ferro conforme a orientação do médico. A ingestão de iodo, importante para o desenvolvimento neurológico do feto, também deve ser adequada, e pode ser obtida em frutos do mar, laticínios e sal iodado.
Para aquelas que seguem uma dieta vegetariana ou vegana, a suplementação de vitamina B12 pode ser necessária para evitar deficiências. As práticas alimentares têm um grande impacto nos resultados da saúde geral, com fortes recomendações recentes sugerindo suplementação diária de ferro para apoiar tanto os níveis de ferro maternos quanto fetais.
Monitoramento e avaliação
As gestações de alto risco exigem monitoramento mais intenso e frequente no pré-natal. Dependendo da gravidade dos fatores de risco, as gestantes podem precisar de consultas quinzenais ou até semanais durante períodos críticos, como nas fases mais avançadas da gravidez.
Avaliações regulares geralmente incluem o monitoramento de peso, pressão arterial e batimentos cardíacos fetais, além de diversos testes diagnósticos para garantir o bem-estar da mãe e do bebê.
Em casos onde há condições pré-existentes, como diabetes ou hipertensão, o PNAR pode ser necessário para otimizar planos de tratamento e ajustar medicações conforme necessário.
Esse acompanhamento pode também envolver outras especialidades, incluindo nutrição, assistência social e suporte à saúde mental.
Gerenciamento da gravidez de alto risco
O gerenciamento de uma gravidez de alto risco envolve uma abordagem multifacetada que prioriza a saúde e o bem-estar da mãe e do bebê em desenvolvimento.
Identificar fatores de risco precocemente, realizar monitoramento frequente e implementar estratégias preventivas são essenciais para minimizar complicações.
Importância do monitoramento frequente
O monitoramento frequente é fundamental em gestações de alto risco, pois permite uma avaliação contínua da saúde do bebê, a detecção precoce de possíveis complicações e a intervenção oportuna, se necessário.
As visitas pré-natais regulares incluem verificações de peso, medições de pressão arterial e exames dos batimentos cardíacos do bebê (BCF). Por exemplo, uma mulher com gravidez de alto risco pode ter consultas a cada duas semanas após 28 semanas de gestação, aumentando para consultas semanais na presença de fatores de risco significativos.
O monitoramento contínuo não apenas ajuda a avaliar o crescimento e desenvolvimento do bebê, mas também tranquiliza a mãe quanto ao seu estado de saúde.
Fatores de risco para gestação de alto risco
Gestações de alto risco podem ser causadas por uma variedade de fatores, que podem ser classificados em condições de saúde (como diabetes, pressão alta), escolhas de estilo de vida (como tabagismo, consumo de álcool), fatores genéticos e influências ambientais (como grandes altitudes, exposição à radiação).
Compreender esses fatores de risco é fundamental para implementar estratégias de manejo adequadas e garantir um resultado saudável para a gravidez.
Princípios de gerenciamento da gestação de alto risco
O gerenciamento eficaz de gestações de alto risco depende da identificação proativa dos fatores de risco, de consultas regulares e da educação sobre possíveis complicações.
Os profissionais de saúde devem facilitar o suporte psicossocial para a mãe e sua família ao longo da gravidez e estar prontos para encaminhar as pacientes a especialistas quando necessário.
Complicações potenciais
As gestações de alto risco estão associadas a uma maior probabilidade de complicações que podem gerar efeitos adversos tanto à mãe quanto ao bebê.
Essas complicações podem resultar de variados fatores médicos, condições de saúde materna ou problemas fetais, e a gravidade dessas condições pode influenciar significativamente o gerenciamento e os resultados da gravidez.
Complicações comuns
Entre as complicações mais comuns que podem ocorrer durante o PNAR, destacam-se:
Parto prematuro: Um dos riscos mais significativos é o parto prematuro, definido como um parto que ocorre antes das 37 semanas de gestação. Bebês nascidos prematuramente estão em maior risco de enfrentar desafios no desenvolvimento e problemas de saúde, como dificuldades respiratórias e baixo peso ao nascer.
Baixo peso ao nascer: Bebês provenientes de gestações de alto risco têm maior probabilidade de nascer com baixo peso, o que pode levar a várias complicações, como atrasos no desenvolvimento e maior suscetibilidade a infecções.
Hipertensão e pré-eclâmpsia: Condições como hipertensão e pré-eclâmpsia podem surgir durante gestações de alto risco. A pré-eclâmpsia, caracterizada por pressão alta após 20 semanas de gestação, representa riscos graves para a mãe e o bebê, podendo levar a convulsões (eclâmpsia) ou até mesmo ao coma.
Aborto espontâneo ou natimorto: O risco de aborto espontâneo ou natimorto pode ser maior em gestações de alto risco, especialmente quando há questões de saúde subjacentes ou problemas com o desenvolvimento fetal.
Gestações de alto risco exigem um acompanhamento mais detalhado e rigoroso para assegurar os melhores resultados possíveis para a mãe e o bebê.
O entendimento das causas e fatores de risco, aliado a uma gestão adequada e monitoramento contínuo, pode ajudar a mitigar complicações potenciais.
Referências
Title: High-Risk Pregnancy and Mental Health | Postpartum Support ...
Url: https://www.postpartum.net/high-risk-pregnancy-and-mental-health/
Highlights: A high-risk pregnancy is commonly accepted as a pregnancy in which the mother or baby, or both, are at an increased risk of complications as a direct result of the pregnancy (Yale Medicine, 2022). Some women are considered high-risk due to preexisting conditions. This can include diabetes, heart disease, hypertension, or a history of significant issues in past pregnancies. Even the age of the mother can cause the pregnancy to be considered high-risk. Some common pregnancy-related complications can include pre-eclampsia, placenta previa, multiple babies (twins, triplets, etc.), gestational diabetes, and preterm labor. With these conditions, more frequent medical appointments can be necessary. Additionally, some women will end up being placed on bed rest. This can significantly impact the mother and her family. How Does a High-Risk Pregnancy Impact Mental Health?
Title: Can Midwives Handle High-Risk Pregnancies? - Orlando Health
Url: https://www.orlandohealth.com/content-hub/can-midwives-handle-high-risk-pregnancies
Highlights: A pregnancy is high risk when either the mother, baby or both have a greater chance of experiencing complications during pregnancy or delivery. Some women are at a high risk of complications before they get pregnant, while others become high risk as the pregnancy progresses. Women who are at high risk before becoming pregnant include those who: - Are 35 or older - Are obese (BMI of 30 or higher) - Experienced problems with a previous pregnancy, like multiple miscarriages or preterm labor - Have pre-existing medical conditions, such as diabetes or high blood pressure. Factors that may cause a pregnancy to become high risk as it progresses include: - Birth defects or genetic conditions detected during prenatal screenings - Carrying multiple babies - Gestational diabetes - Preeclampsia, high blood pressure that develops during pregnancy.
Title: High-Risk Pregnancy: An Overview of What Can Go Wrong and How High ...
Highlights: Tobacco and alcohol are to be avoided, Dr. Lauring says, and so are addictive drugs, from painkillers to illegal substances. “Some people use more than one substance, so it can be hard to tease out which one is responsible for putting a pregnant woman in harm’s way. Medical and socio-economic factors also are associated with substance use. Hopeful mothers-to-be should seek help with any substance issues—preferably before she gets pregnant.” What if she’s expecting “multiples”—twins, triplets or more? The more babies, the more possible complications, she says. “The risk of premature birth at 35 to 36 weeks increases when a woman is expecting more than one baby. (A normal pregnancy typically lasts 40 weeks.) As well, multiples increase the risk of all the conditions and complications referred to above, such as diabetes, pre-eclampsia and stillbirth. If a woman has had a previous preterm birth, does that increase her risk of having another?Older maternal age—over 35—is an independent risk factor for pregnancy complications, including: - High blood pressure - Stillbirth - Genetic abnormalities and miscarriages (the two are linked) - Babies who don’t grow well during pregnancy Young age can pose a number of dangers as well. According to the World Health Organization (WHO), adolescent mothers aged 10 to 19 face higher risks of eclampsia, puerperal endometritis—an infection of the lining of the uterus after giving birth—and systemic infections compared to women in their early 20s. Babies of adolescent mothers may be prone to low birth weight, preterm birth and severe neonatal conditions. What is the impact of substance use on pregnancy?Obesity, defined as having a BMI of 30 and up, increases the above-mentioned risks as well, especially to the developing fetus. Obesity is linked to high blood pressure and a variety of other medical disorders. The good news, says Dr. Lauring, is that all of these can be controlled via: - Medication, including insulin for diabetes - Periodic ultrasounds to see how the fetus is developing - Close monitoring and follow-up What is the difference between pre-eclampsia and eclampsia? When a woman with pre-eclampsia has seizures, it’s diagnosed as eclampsia. Eclampsia typically occurs around the time a woman gives birth, but it can happen to women with pre-eclampsia as well, or even before a diagnosis of pre-eclampsia. In that case, eclampsia can be the first sign that something is wrong. Both conditions are considered serious and even potentially life-threatening. How might a woman’s age affect pregnancy?
Title: High-Risk Pregnancies: Risk Factors & Preventing Complications - WebMD
Url: https://www.webmd.com/baby/managing-a-high-risk-pregnancy
Highlights: Even if you don't have an existing health problem, many doctors recommend a preconception appointment with your health care provider to ensure you are as healthy as you can be before you become pregnant. At this appointment your doctor may recommend steps you can take to reduce the risk of certain problems. These include: - Getting at least 400 micrograms of folic acid daily, starting before and continuing through pregnancy - Getting recommended immunizations - Eating a healthy diet and maintaining proper weight - Getting regular physical activity, unless advised otherwise by your doctor - Avoiding cigarettes, alcohol, and drugs (except for medications approved by your doctor) - Taking only the over-the-counter and prescription medicines that your doctor or midwife has OK’d for you - Seeing your doctor regularly - Working with them to manage problems such as diabetes, depression, high blood pressure, or infectionMaternal age. One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40. Medical conditions that exist before pregnancy. Conditions that can pose risks to the mother or baby include: - High blood pressure - Lung, kidney, or heart problems - Diabetes - Depression - Obesity - Autoimmune disease - Sexually transmitted diseases (STDs) - Long-term (chronic) infections such as human immunodeficiency virus (HIV) A history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are also risk factors for a high-risk pregnancy.- Premature labor is labor that begins before 37 weeks of pregnancy. About 12% of babies born in the U.S. are born early. Preemies have higher odds of health problems or developmental delays later on. Although there is no way to know which women will have preterm labor or birth, there are factors that place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth. - Multiple births means you are carrying more than one baby (twins, triplets, quadruplets, etc.). Multiple pregnancies, which are more common as women are using more infertility treatments, increase the risk of premature labor, gestational diabetes, and pregnancy-induced high blood pressure. These babies have a higher risk for long-term health problems such as delayed development or cerebral palsy. But keep in mind that most multiples are born healthy.- Gestational diabetes is a type of diabetes that develops during pregnancy. Women with gestational diabetes may have healthy pregnancies and babies if they follow the treatment plan from their health-care provider. Usually, the diabetes resolves after delivery. However, women with gestational diabetes are at increased risk of developing type 2 diabetes and high blood pressure. You may need a C-section instead of vaginal birth to prevent injury to your baby. Your risk of gestational diabetes goes up if you are over 25, are pregnant with multiples, are overweight, or have had gestational diabetes or a very large baby in the past, or if someone in your family has diabetes.
Title: High-Risk Pregnancies: Risk Factors & Preventing Complications - WebMD
Url: https://www.webmd.com/baby/managing-a-high-risk-pregnancy
Highlights: Even if you don't have an existing health problem, many doctors recommend a preconception appointment with your health care provider to ensure you are as healthy as you can be before you become pregnant. At this appointment your doctor may recommend steps you can take to reduce the risk of certain problems. These include: - Getting at least 400 micrograms of folic acid daily, starting before and continuing through pregnancy - Getting recommended immunizations - Eating a healthy diet and maintaining proper weight - Getting regular physical activity, unless advised otherwise by your doctor - Avoiding cigarettes, alcohol, and drugs (except for medications approved by your doctor) - Taking only the over-the-counter and prescription medicines that your doctor or midwife has OK’d for you - Seeing your doctor regularly - Working with them to manage problems such as diabetes, depression, high blood pressure, or infectionMaternal age. One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40. Medical conditions that exist before pregnancy. Conditions that can pose risks to the mother or baby include: - High blood pressure - Lung, kidney, or heart problems - Diabetes - Depression - Obesity - Autoimmune disease - Sexually transmitted diseases (STDs) - Long-term (chronic) infections such as human immunodeficiency virus (HIV) A history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are also risk factors for a high-risk pregnancy.- Premature labor is labor that begins before 37 weeks of pregnancy. About 12% of babies born in the U.S. are born early. Preemies have higher odds of health problems or developmental delays later on. Although there is no way to know which women will have preterm labor or birth, there are factors that place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth. - Multiple births means you are carrying more than one baby (twins, triplets, quadruplets, etc.). Multiple pregnancies, which are more common as women are using more infertility treatments, increase the risk of premature labor, gestational diabetes, and pregnancy-induced high blood pressure. These babies have a higher risk for long-term health problems such as delayed development or cerebral palsy. But keep in mind that most multiples are born healthy.- Gestational diabetes is a type of diabetes that develops during pregnancy. Women with gestational diabetes may have healthy pregnancies and babies if they follow the treatment plan from their health-care provider. Usually, the diabetes resolves after delivery. However, women with gestational diabetes are at increased risk of developing type 2 diabetes and high blood pressure. You may need a C-section instead of vaginal birth to prevent injury to your baby. Your risk of gestational diabetes goes up if you are over 25, are pregnant with multiples, are overweight, or have had gestational diabetes or a very large baby in the past, or if someone in your family has diabetes.
Title: Levels of Maternal Care - ACOG
Highlights: Definitions of Levels of Maternal CareBecause obesity is extremely common throughout the United States, all facilities should have appropriate equipment for the care and delivery of pregnant women with obesity, including appropriate birth beds, operating tables and rooms, and operating equipment 34. The degree of obesity may be one of the factors that affects decisions for transfer of a woman to a higher level of care, although there are no well-established body mass index cut-off levels to determine level-specific care for pregnant women or women in the postpartum period with obesity. Because of the importance of accurate data for the assessment of outcomes and quality indicators, all facilities should have infrastructure and guidelines for data collection, storage, and retrieval that allow regular review for trends.
Title: Care for High Risk Pregnancy - Brigham and Women's Hospital
Url: https://www.brighamandwomens.org/obgyn/resources/high-risk-pregnancy
Highlights: Header Skipped. Having a high-risk pregnancy means that a woman has a greater chance of complications because of conditions in her pregnancy, her own medical status, or external factors. Many times, complications are unexpected and may occur without warning. Other times, there are certain risk factors that make problems more likely. Planning a pregnancy? An important part of planning is finding out if you have any risks. Pregnancy risk factors include: Other factors also can pose a risk to your developing baby. These include high temperatures, radiation exposure, and high altitudes.Our Division of Maternal-Fetal Medicine, also known as High-Risk Obstetrics, provides expert, multidisciplinary care for women and newborns who have complications identified prior to or during pregnancy. Our Center for Fetal Medicine and Prenatal Genetics provides comprehensive assessment and treatment of fetal disease. Women without pregnancy complications also are welcome for services, including genetic counseling. High-risk newborns are cared for by the specialty staff at our on-site Neonatal Intensive Care Unit (NICU) and Boston Children’s Hospital – connected by a pedestrian bridge to Brigham and Women’s Hospital. The faculty members and researchers at the BWH Department of Obstetrics and Gynecology are dedicated to doing everything possible to provide women and their families with the most advanced care available anywhere.
Title: High-risk pregnancy - Wikipedia
Url: https://en.wikipedia.org/wiki/High-risk_pregnancy
Highlights: - Infections: Early and regular prenatal care is important. A provider should be consulted about options including prevention via medication prophylaxis or vaccines, and treatment such as appropriate use of antibiotics (ex. for congenital syphilis) or antifungals. Another option for prevention of transmission includes delivery via Caesarian delivery. Anxiety surrounding "high-risk pregnancy" label [edit]The concept of a high-risk pregnancy has been shown to elicit a strong emotional response in some pregnant women, including fear, anger, and guilt. In addition, some studies show that a pregnancy labeled "high-risk" may lead to more unnecessary testing than without the label, increasing these fears and reducing the pregnant woman's sense of control over the situation. Managing anxiety in pregnancies deemed high-risk has been deemed an important focus in research, although there is currently limited high-quality studies on the issue.
Title: 12.2: Preconception Conditions Affecting Pregnancy
Highlights: To support patients of low socioeconomic status, nurses can connect patients with local resources, provide education on prenatal care, offer emotional support, and refer for financial assistance. Health-care providers can advocate for patients by providing referrals, collaborating with social services, and encouraging patient self-advocacy. The nonprofit Hastings Center provides links to programs developed to increase access to care and are available to persons who are pregnant, postpartum persons, and infants. Migrant Farm WorkIron needs during pregnancy often vary by patient, and iron can be obtained through prenatal vitamins, animal products, or iron-fortified foods. Adequate iodine intake supports fetal neurodevelopment and can be found in seafood, eggs, dairy products, and iodized salt (USDA, 2020). Vitamin B12 is most commonly found in animal products, so patients with a vegan or vegetarian diet may require supplementation. On initial assessment, the health-care team can evaluate the patient’s dietary habits to evaluate for deficiencies in micronutrients. The nurse uses this information to assist the patient in identifying acceptable sources of needed nutrients to add to their daily intake.Patients with preexisting medical conditions often require a multidisciplinary approach to monitor maternal and fetal health before, during, and after pregnancy. A preexisting medical condition is one that is present prior to conception. High-risk pregnancies are often followed up by a maternal-fetal medicine specialist in addition to an obstetrician or midwife. Depending on the medical condition, additional specialties may be involved in patient care, including neonatology, nutrition, pharmacy, social work, case management, cardiology, nephrology, endocrinology, hematology, neurology, pulmonology, infectious disease, and others. The role of the nurse in this team is to educate the patient about why these additional specialties are needed, to encourage adherence to the overall care plan, and to support the patient in coordinating care.Dietary habits play an important role in preventing anemia. Diets deficient in iron, folate, and vitamin B12 can lead to anemia. For the prevention of iron deficiency anemia during pregnancy, current recommendations include taking a daily iron supplement to support maternal and fetal iron levels (National Academies of Sciences, Engineering, and Medicine, 2020). Patients can be encouraged to increase iron levels by consuming foods rich in iron, such as meats, beans or legumes, green leafy vegetables, iron-fortified cereals or whole grains, nuts, seeds, and dried fruits, shown in Figure 12.3. Caffeine intake through tea and coffee can inhibit iron absorption, so patients should be counseled to avoid caffeine around mealtimes. As with iron, folic acid can be supplemented through a prenatal vitamin to treat anemia related to folic acid deficiency. Daily requirements for folic acid increase during pregnancy, and folic acid intake can be increased by incorporating dark leafy vegetables, legumes, and animal proteins into a healthy diet.. The nurse should be prepared to teach patients about available medications and their side effects and remind them how to avoid triggers.Homelessness and unstable housing place a pregnancy at risk and have been linked with mental health and substance use disorders (McGeough et al., 2020). Factors related to homelessness include inadequate prenatal care, unsafe living conditions, exposure to environmental hazards, increased stress, and limited access to food. These factors are associated with an increase in morbidity and mortality for both the pregnant person and the fetus.Opioids may be prescribed, such as methadone and codeine, or nonprescribed, such as heroin. Opioid use during pregnancy increases the risk for maternal mortality, stillbirth, preterm birth, and neonatal abstinence syndrome (NAS) (Centers for Disease Control & Prevention [CDC], 2022a). Opioid use disorder can be linked with other comorbidities, including alcohol, benzodiazepine and stimulant use, poor nutrition, domestic violence, exposure to bloodborne pathogens, and inconsistent prenatal care (Wilson et al., 2020). Additional screening and testing may be indicated to evaluate for these comorbidities. Patients who become pregnant and use illicit drugs may be prescribed a safer alternative, such as methadone or buprenorphine, and referred to a treatment program to minimize withdrawal and prevent relapse (ACOG, 2017b). After birth, the infant will need to be monitored closely by a pediatric provider for signs of withdrawal.The health-care team will evaluate the patient’s support system, psychologic status, and access to resources. Steps toward pregnancy prevention can minimize the risk of pregnancy. Nursing interventions at an individual level include education on contraceptives and prenatal care. The nurse can refer the patient to resources such as social support groups, counseling, and educational programs. Local programs such as Women, Infants, and Children (WIC) can provide additional support to adolescents, including prenatal nutrition classes, breast-feeding assistance, referrals for immunizations, employment assistance, and other social services.Patients who are pregnant and experience homelessness may be at increased risk for physical harm and violence. Health-care providers may not be able to reduce the risk factors associated with homelessness but should instead focus on supporting the unique needs of the individual patient. Policy changes on a broader scale aimed at assisting with unemployment, supplying adequate housing, and reducing domestic violence can reduce the incidence of homelessness during pregnancy. Nurses can advocate for people experiencing homelessness by referring them to social services or WIC to help find prenatal classes where there is also access to prenatal vitamins and vouchers for more nutritious foods. Substance Use. Patients should be encouraged to adhere to the medication regimen, which can take several months, in order to eradicate the infection. Medications for active tuberculosis include isoniazid (Nydrazid), rifampin (Rifadin), and ethambutol (Etibi). All these drugs have an excellent safety record in pregnancy and are not associated with human fetal malformations. Monitoring for liver dysfunction, hepatitis, and medication interactions during treatment is generally recommended. A patient with tuberculosis should be placed in a negative pressure room on hospital admission to prevent the spread of infection. Untreated tuberculosis may increase the risk for low birth weight in the infant or, in rare cases, congenital tuberculosis (Leidecker & Dorman, 2016).
Title: Mental Health During Pregnancy - NAMI
Url: https://www.nami.org/your-journey/maternal-new-parent-mental-health/mental-health-during-pregnancy/
Highlights: Be aware of the risks to you and the future baby. Poor nutrition puts your future baby at higher risk for low birth weight, preterm delivery, or birth defects. However, merely changing your diet without addressing the emotional drivers may not provide a long-term solution. - Talk to both your health care and mental health care providers about an integrated plan. Seek therapy and nutritional advice from registered dietitians to address both the physical and emotional aspects of your health. Find out about specialty groups. Get help if you find yourself in a crisis. If you exhibit purging, overexercising, severely limiting food intake, or rapid body changes, seek immediate medical assistance. - Talk to your health care provider about inpatient programs equipped for pregnancy or residential eating disorder facilities to assure stabilization for you and your future baby.- Work closely with both your mental health care provider and your health care provider to assess these options. - Discuss all choices openly, including the possibility of making no medication changes. The physical transformation of pregnancy often comes hand in hand with mental and emotional shifts. Feeling anxious about labor, the baby’s health, or lifestyle changes is not unusual. Being aware of your mental health during pregnancy empowers you to get the assistance you might need. Here are some things you can do: Identify risk factors for prenatal depression. If you’ve experienced depression, stressful life events, trauma, or grief, you may be at higher risk for prenatal depression. - Pay attention to shifts in your mood, appetite, and sleep patterns. - Take proactive steps by reaching out early to join a support group, enroll in talk therapy, or let your health care provider know about your experiences.
Title: High-Risk Pregnancy: What You Need to Know - Johns Hopkins Medicine
Highlights: - Pre-existing medical condition. There are many pre-existing medical conditions that may need to be monitored in relation to pregnancy, e.g., diabetes , lupus , renal disease and hypertension (high blood pressure). In some instances, a maternal-fetal medicine specialist may alter the type of medication you’re taking to maintain your health and prevent any adverse effects to your future pregnancies. If you have diabetes, a maternal-fetal medicine specialist can help you optimize your blood sugar control prior to conception to help reduce the risk of fetal anomalies. If you struggle with obesity , a maternal-fetal medicine specialist can review the benefits of weight loss before pregnancy. According to Henderson, “Losing weight in a healthy manner can reduce your risk of developing conditions such as hypertension and gestational diabetes during pregnancy.”- Genetic risks. Preconception genetic screening has become more common in recent years as technology has advanced and testing has become more accessible. If you have family members with a certain disease or if you belong to an ethnicity that has a greater risk of developing specific conditions (such as sickle cell disease or Tay-Sachs disease), genetic screening can be used to assess your and your partner’s risk of being a carrier. Also, common genetic conditions, such as cystic fibrosis or spinal muscular atrophy , can be screened for with a blood test. Additionally, if you have a child affected by a genetic disorder or syndrome, a maternal-fetal medicine specialist can provide counseling and management to consider how the condition may impact your future pregnancies. Always speak with your health care provider to determine what’s best for you and your pregnancy. Q: What conditions may lead to a high-risk pregnancy?
Title: High-Risk Pregnancy: Age Factor & Prevention Techniques - Vaia
Url: https://www.vaia.com/en-us/explanations/nursing/midwifery/high-risk-pregnancy/
Highlights: In a high-risk pregnancy, the probability and severity of complications can be significantly higher for both mother and baby. These complications can arise due to various factors, as was previously outlined. It is essential to be aware of these potential complications as they have major implications for prognosis and management strategies. Possible Complications in a High-Risk Pregnancy The possible complications that may arise during a high-risk pregnancy are varied and can affect both the mother and the baby. These complications may range from premature birth to a number of health conditions for the mother, or birth defects and growth restriction for the baby.For instance, in an ultrasound exam specific to high-risk pregnancies (e.g., a detailed or 'level II' ultrasound), the healthcare provider may take a closer look at the baby's heart, brain, and other organs, and at physical features such as the nuchal fold (the area at the back of the baby's neck). Specific markers for Down syndrome and other genetic disorders can also be checked. Importance of Frequent Monitoring in High-Risk Pregnancies Frequent monitoring is of the utmost importance in high-risk pregnancies. It allows for ongoing assessment of the baby's health, early detection of potential complications, reassurance of wellbeing, and timely intervention if needed. So, why is frequent monitoring so critical in high-risk pregnancies? Assessment of Baby's Health: Routine and frequent check-ups provide ongoing assessment of the baby's growth and development. Potential issues can be identified and managed to ensure the health of both mother and baby.Regular Exercise: Keeping active with moderate exercise like brisk walking or swimming can help maintain a healthy weight, improve circulation, reduce pregnancy discomfort, and boost your mood. However, always consult your healthcare provider before starting or continuing any exercise routine. Hydration: Keeping yourself hydrated is crucial, more so during pregnancy. It helps in maintaining amniotic fluid levels and can aid in preventing health issues such as headaches, urinary tract infections, and premature labour. Staying Up-to-Date with Vaccinations: It's essential to be up-to-date with your immunisations in order to protect your unborn baby from contracting any diseases. Certain vaccinations are recommended during pregnancy, such as Influenza and Tdap (Tetanus, Diphtheria and Pertussis).Midwifery, in essence, is a health profession distinct from nursing, which offers care designed for women, especially during pregnancy, childbirth, and postpartum period. This also includes care for newborns and family planning. As a midwife, you will be central to the management of high-risk pregnancies. You'll provide an array of services from preconception counselling to post-natal care. To elaborate: - You will identify and refer a woman with a high-risk pregnancy to obtain the appropriate specialist care required. - With a constructive approach, you will facilitate psychosocial support to the woman and her family throughout her pregnancy. - You will play an active role in planning and managing the childbirth, be it normal or through any other medical intervention such as a Caesarean section. - You will contribute towards the postnatal care and ensure medical, nutritional, and emotional needs are addressed for both the mother and her baby.Education: Midwives provide counselling and education to women about potential risks and complications, helping them understand the best ways to manage their health condition during pregnancy. Let's assume a pregnant woman has a higher chance of preterm labour due to her age. The midwife would educate her about the signs of premature labour, the steps she should take if she experiences these symptoms, and discuss the care plan put in place. Sometimes, the complexity of complications may require attention from an obstetrician or another healthcare specialist, here again, midwives play a crucial role. Referrals: When high-risk conditions are beyond their realm of management, midwives refer women to appropriate healthcare professionals for specialised care. They maintain a collaborative relationship with these professionals to ensure a comprehensive care plan.Fetal Movement Tracking: Monitoring your baby's kicking and twisting movements can provide important clues about his or her well-being. Decreased or absent fetal movements can be sign of distress. For instance, one common method used to track fetal movement is 'count to ten.' You lie on your side and count the number of times you feel your baby move. Most women should feel the baby move at least ten times within two hours. If the baby moves less, it's recommended to contact your healthcare provider. Several diagnostic and screening tests are available for high-risk pregnancies. Diagnostic and Screening Tests: Pregnancies with high-risk factors may require additional tests to monitor the health of the baby more closely. These tests can include specialist ultrasound scans, blood tests, and invasive tests like amniocentesis or chorionic villus sampling.- Risk Factors for High-Risk Pregnancy: These can be divided into health conditions (such as diabetes, high blood pressure, HIV, or auto-immune disorders), genetic factors, lifestyle choices (like smoking, alcohol consumption, drug use, and inadequate prenatal care), and environmental factors. - High-Risk Pregnancy Management Principles: Being proactive and identifying the risk factors early is essential to manage high-risk pregnancies effectively. Regular checkups, mental health care, health education, and modifications in lifestyle habits are important components of managing such pregnancies. - Prevention Strategies for High-Risk Pregnancy: These include prepregnancy planning, maintaining a healthy weight, quitting smoking and abstaining from alcohol and drugs, regular exercise, mental health care, and staying up-to-date with vaccinations.Monitoring and Evaluating High-Risk Pregnancies Monitoring and evaluating a high-risk pregnancy involves a multifaceted approach that includes frequent prenatal visits, tracking fetal movements, and a variety of diagnostic tests and scans. The monitoring strategies will depend on the specific risk factors associated with the pregnancy. Prenatal Visits: Regular clinical check-ups allow healthcare providers to track the health of both you and your baby. These visits may include weight check, blood pressure measurement, and examination of the baby's heart rate. For instance, a woman with a high-risk pregnancy might have prenatal visits every two weeks from 28 weeks of gestation, or even weekly if very high-risk factors are present. This is compared to a low-risk pregnancy where visits might be scheduled every four weeks until about 28 weeks of gestation, and then two-weekly until 36 weeks. You may be instructed to keep track of your baby's movements daily.Imagine a woman, who is an active smoker and has uncontrolled diabetes. In this case, she's at an extremely high risk during pregnancy because her smoking habit can lead to low oxygen supply and her diabetes can result in a high blood sugar level, both of which are harmful to the baby. Remember, identifying these risk factors early can significantly impact the outcome of a high-risk pregnancy. Being adept at recognizing these factors, as a nurse, is the first step in providing meaningful and timely interventions. Prevention Strategies for High-Risk Pregnancy It's essential to understand the prevention strategies for a high-risk pregnancy. With proper preventive measures in place, it's possible to minimise certain risks and optimise conditions for a safe and healthy pregnancy. The key prevention strategies are maintaining a healthy lifestyle, regular antenatal checkups, and genetic counselling. How to Minimize the Risk of High-Risk Pregnancy
Post escrito e curado por STORM - Stanford University. Acesse aqui.
Revisado pela equipe Ei, Doc! em 11 de novembro de 2024.
