Management of High-Risk Pregnancies

Management of High-Risk Pregnancies

DOI: 10.4018/978-1-7998-4357-3.ch008

Abstract

Rarely does a pregnancy happen without any complication. The majority of these problems are minor and due to normal anatomical and physiological changes occurring during pregnancy. However, some are more serious and require medical attention. Certain conditions that are specific to pregnancy and occur during pregnancy classify it as a high-risk pregnancy. A high-risk pregnancy is closely monitored with antenatal check-ups and possibly an additional care. In labour, certain obstetric complications require an immediate intervention. A high-quality antenatal care means that potentially serious conditions are usually successfully managed, both during pregnancy and in labour. Post-delivery problems, either to baby or to mother, may also need medical attention with careful follow-up and sometimes referral. Thus, providing good antenatal care, finding appropriate ways of preventing, and dealing with consequences of unwanted pregnancies and improving the way society looks after pregnant women are the three most important ways to reduce maternal mortality in high risk pregnancies.
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Key Facts

  • Nevertheless, maternal mortality ratios, ranging from less than five maternal deaths per 100 000 live-births in high-income countries to more than 500 per 100 000 live births in several countries in Sub-saharan Africa, remain among the least equitable of all health indicators, (WHO, UNICEF, UNFPA, World Bank, 2010).

  • In the African Region, the maternal mortality ratio at an average of 940 per 100,000 live births, is the highest in the world (WHO, 2000).

  • The estimated number of women, who die each year from causes related to pregnancy or childbirth, has dropped substantially from 543, 000 deaths in the year 1990 to about 287, 000 in the year 2010 (WHO, UNICEF, 2013; WHO, UNICEF, UNFPA, World Bank, 2010).

  • Sadly, most countries are expected not to achieve the maternal mortality target set for the Millennium Development Goals (WHO, UNICEF, 2013).

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Introduction

In many parts of the world, an early marriage is still a norm. Generally, early marriage results in early motherhood. However, in many developing countries, at least 20 per cent of women give birth to their first child before the age of 18 years while in some other countries, about half of all women give birth to their first child before the age of 18 years. The parents, in-laws and society's expectations are to give birth to a child as soon as possible after marriage. Many young women are under pressure to carry sons. This typically leads to pregnancies being spaced too close together, in addition to occurring too soon in the life of the young mother.

Women, who marry or enter union at a young age, are likely to have their partners who are much older in age than they are; which is sometimes as old as 15 years older in some countries. This difference in age of the partners reduces the chance that the woman will be able to participate in decision making process about childbearing or be able to negotiate the use of the contraceptives.

Data from 21 countries with full statistics revealed that the pregnancy rate among adolescents, aged 15 to 19 years, was the maximum in the United States (57 pregnancies per 1,000 females) and minimum in Switzerland (8 pregnancies per 1,000 females). Data from some former Soviet countries with incomplete statistics revealed these rates to be higher. With the available information, these rates were highest in Mexico and Sub-saharan African countries. Hungary had the highest pregnancy rate among 10 to 14-year-old adolescents, as reported among countries with reliable evidence. The proportion of abortion-induced adolescent pregnancies ranged from Slovakia (17 percent) to Sweden (69 percent). The proportion of pregnancies resulting in live births remained higher in countries with high rates of adolescent pregnancies. Since mid-1990’s, the pregnancy rates have fallen in majority of the 16 countries where these trends could be assessed (Sedgh et al, 2015).

Reviews of earlier country-wide studies on rates of adolescent pregnancy and childbearing covered trends up to the mid-1990’s. Results revealed that such events became less common in most of the countries with available evidence (Singh and Darroch, 2000; Singh, 1998). At that time, the rate of adolescent pregnancy was higher in the United States than any other developed country with available estimates, except Russia. Region-wise estimates of developing countries indicated adolescent birth rates in Sub-Saharan Africa to be particularly high (National Research Council, 2005).

Despite the recent declines in child bearing rates, rates of adolescent pregnancy remain too high in most of the countries. Research evidence on the planning status of such pregnancies and the factors which determine the ways adolescent mothers use to resolve their pregnancies could further shape the maternal and child health programs and policies.

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