What are the key risk factors to consider when assessing a pregnant patient for high-risk complications?

When assessing a pregnant patient for high-risk complications, key risk factors encompass a broad range of pre-existing medical conditions, obstetric history, and current pregnancy complications that necessitate careful multidisciplinary evaluation and planning.

Medical conditions indicating increased risk include: cardiovascular diseases such as confirmed cardiac disease and hypertensive disorders; respiratory conditions like asthma requiring escalated treatment or cystic fibrosis; haematological disorders including sickle-cell disease, beta-thalassaemia major, history of thromboembolic events, and bleeding disorders; endocrine issues such as hyperthyroidism and diabetes requiring medication; active infections including hepatitis B or C with abnormal liver function, treated toxoplasmosis, and active chickenpox, rubella, or genital herpes; immune disorders like systemic lupus erythematosus and scleroderma; renal diseases with abnormal function or requiring specialist supervision; neurological conditions such as epilepsy and previous cerebrovascular accidents; psychiatric disorders requiring inpatient care; and gastrointestinal or liver diseases with abnormal liver function tests ¹.

Obstetric and pregnancy-related risk factors include: previous severe complications such as unexplained stillbirth, neonatal death, pre-eclampsia requiring preterm birth, placental abruption, eclampsia, uterine rupture, primary postpartum haemorrhage, caesarean birth, and shoulder dystocia; current pregnancy factors like multiple births, placenta praevia, pre-eclampsia or pregnancy-induced hypertension, preterm labour, anaemia with haemoglobin less than 85 g/litre at labour onset, confirmed intrauterine death, substance misuse including alcohol dependency, gestational diabetes needing medication, malpresentation, recurrent antepartum haemorrhage, small for gestational age fetus, abnormal fetal heart rate or Doppler studies, and abnormal amniotic fluid volumes ¹.

Additional considerations include women with no antenatal care, who require obstetric-led intrapartum care due to increased risk ².

Risk assessment should be multidisciplinary, involving midwives, obstetricians, anaesthetists, physicians with expertise in the relevant medical conditions, and the woman’s GP, ensuring shared decision-making and individualized care plans ².

Specifically for cardiac disease, risk stratification follows the modified WHO classification, with some women at low risk managed per standard intrapartum care and others requiring specialist input (Chan, 2020).

Continuous monitoring and maternal observations are essential for women with complications such as fever, sepsis, intrapartum haemorrhage, or fetal growth concerns to promptly identify deterioration ².

In summary, the key risk factors to consider are comprehensive and include pre-existing medical conditions, previous obstetric complications, current pregnancy complications, and social factors such as substance misuse or lack of antenatal care, all requiring coordinated multidisciplinary management to optimize maternal and fetal outcomes ¹,²(Chan, 2020)(Habek, 2024).