Antenatal Record - Family Medicine Reference (Page 2 of 4) in pdf

A Guide to Pregnancy Assessment

In the event of maternal transfer, please photocopy the front sheet and send to referral hospital.

This assessment system is intended as a basis for planning the on-going management of the pregnancy and should

reflect local resources. The risk factors or problems listed below are intended as examples only.

Healthy Pregnancy, no predictable risk:

No pregnancy complications now or in the

No prior perinatal morbidity or mortality

past

Fetal growth adequate

No significant maternal medical disease

Pregnancy at risk:

The fetus/mother may be at risk. Closer observation of the pregnancy may be necessary. In addition, consultation with

an appropriate specialist (obstetrician, internist, pediatrician, etc.) may also be necessary. These patients may be

managed by continuing collaborative care and birth in an obstetrical unit with intermediate level nursing facilities OR they

may be returned to the care of the referring provider with a suggested plan of management for the remainder of the

pregnancy.

Maternal factors:

Current pregnancy complicated by:

Diabetes, White Classes B, C, or D

Gestational hypertension

Chronic hypertension

Placenta previa (with or without bleeding)

Other significant medical illness

Other significant antepartum hemorrhage

Obesity (BMI

35)

Twin pregnancy

Significant tobacco, alcohol, drug use

Gestational diabetes (White Class A)

Severe psychosocial issues

Abnormal fetal growth (suspected intrauterine growth

restriction or large for dates)

Family history genetic disease or congenital

anomalies

PROM 32-36 weeks

Other significant family history, esp. DVT/PE

Preterm labour 32-36 weeks

and recurrent pregnancy losses

Rh or atypical blood group sensitization

Prior pregnancy history of:

Hydramnios or oligohydramnios

Preterm labour < 36 weeks

Fetal malposition (breech, transverse) at 36 weeks

Stillbirth or neonatal death

Postdates

41 weeks

Intrauterine growth restriction

Anemia not responding to Fe (Hb <100 g/l)

Previous uterine surgery including lower

__________________________________

segment Cesarean section

Cervical incompetence

Pregnancy at high risk:

Pregnancies which are so complicated that the fetus and/or mother are obviously in danger. If at all possible, these

patients should be transferred to a regional perinatal centre (level lll) for intensive care and birth. Clearly, there are

patients who deserve to be placed in this risk category (with problems such as excessive antepartum bleeding, cord

prolapse, or advanced uncontrolled premature

labour) who cannot be transferred safely or in time to benefit the fetus or mother.

Pregnancy < 32 weeks with:

High order multiple gestation (triplets or greater)

Preterm labour and/or premature rupture

Fetal congenital anomaly

Gestational hypertension with adverse conditions

Diabetes beyond Class D (end-organ

involvement)

Antepartum hemorrhage ongoing

Renal disease with hypertension

function

Oligohydramnios

Heart disease, especially with failure

IUGR,

%, reverse flow Doppler

Other significant severe medical illness

_______________________________________

Two or more risk problems can combine to produce a high pregnancy risk. Such a patient may need

to be placed in a higher risk category

Antenatal Record - Family Medicine Reference Page 2

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