Assignment midwifery 1

Risk factors in high Risk pregnancy
Iron-Deficient Anemia
Many adolescent girls are deficient in iron because their low protein intake
cannot balance the amount of iron lost with menstrual flows. Deficiency is
revealed by chronic fatigue, pale mucous membranes, and a hemoglobin
level less than 11 g/dL. As if the girl’s body has identified a mineral lack,
iron-deficiency anemia is associated with pica, or the ingestion of inedible
substances. Cravings for ice cubes or candy bars may develop because of
this. A pregnancy compounds iron-deficiency anemia because a girl must
now supply enough iron for fetal growth and her increasing blood volume. All
pregnant women should take an iron and folic acid supplement . This is
especially important for the adolescent. Help a girl plan a daily time for
taking her iron supplement
Preterm Labour
Adolescents are at high risk for preterm labor, probably because their
uteruses are not fully grown. Review the signs of labor with them by the 3 rd
month of pregnancy. Stress that labor contractions begin as only a sweeping
contraction no more intense than menstrual cramps. Also, any vaginal
bleeding is suspicious of labor and should be reported. Adolescent girls have
gained much of their knowledge of labor from television . Therefore, they
may dismiss light contractions as simple discomfort, not realizing they might
be the start of labor. Adolescents who recognize labor contractions early on
can seek care to have premature labor halted.
Cephalopelvic Disproportion
Because their own development is still immature, adolescents are prone to

cephalopelvic disproportion. Cephalopelvic disproportion is suggested by lack
of engagement at the beginning of labor, a prolonged first stage of labor,
and poor fetal descent. Graphing labor progress is a good way to detect labor
that is becoming abnormal. Be certain the adolescent has a support person
with her in labor so she can relax and breathe effectively with contractions. If
this person is also an adolescent, you may need to serve as the true support
person, or at least spend considerable time coaching so he or she can
support the girl in labor.
Postpartum Hemorrhage
Young adolescents are more prone to postpartum hemorrhage than the

average woman because if a girl’s uterus is not yet fully developed, it
becomes overdistended by pregnancy. An overdistended uterus does not
contract as readily as a normally distended uterus in the postpartum period.
Adolescents also may have more frequent or deeper perineal and cervical
lacerations than older women because of the size of the infant in relation to
their body.
Inability to adapt postpartally
The immediate postpartum period may be an almost unreal time for an

adolescent. Giving birth is such a stress and a major crisis that all women
have difficulty integrating it into their life. It may be particularly difficult for
the adolesce. The girl may “block out” the hours of labor as if they didn’t
happen. If she was particularly frightened by labor, she may have received a
narcotic, so her memory of the labor hours may not be clear. Urge her to talk
about labor and birth to make the happening real to her; other- wise,
postpartum depression can occur.
Lack of knowledge About Infant Care
Adolescents show the same positive bonding behavior with their infants as
their more mature counterparts. They may, however, lack knowledge of
infant care. Although they may consider themselves to be knowledgeable in
child care. They can be overwhelmed in the postpartum period to realize that
when the baby is their own, child care is not as simple as it once seemed.
When the child cries, they cannot hand it to someone else; at the end of 4
hours, when they are tired of caring for the baby, they cannot leave and walk
away. Although these things were most likely discussed with an adolescent
during pregnancy, these feelings may not arise until the child is actually
born. Unfortunately, most adolescent mothers do not breast- feed. This is
related to their perception of breast-feeding as something that will “tie me
down” and the reality that they will be returning to school full- time soon
after birth.
Cancer and Pregnancy
Although immuno- logic mechanisms are altered during pregnancy, there is

no proof that pregnant women are more prone to cancer than other women
or that pregnancy changes the course of existing disease. If a woman is in
the first trimester of pregnancy when a malignancy is diagnosed, she and
her partner are asked to make a difficult decision: to delay treatment to
avoid teratogenic risks to a fetus from treatment (possibly increasing a
woman’s risk): to abort the pregnancy to allow chemotherapy or radiation
treatment to be initiated; or to choose chemotherapy or radiation treatment
with the almost certain knowledge that they will cause birth anom- alies in
the fetus. As a rule, women can receive chemotherapy in the second and
third trimesters without adverse fetal effects. Radiation therapy, in contrast,
another modality that is a mainstay of cancer therapy, puts the fetus at risk
through- out pregnancy if the fetus is directly exposed. Surgery to remove a
tumor can be completed during pregnancy with the understanding that the
fetus is at risk for anoxia during anesthesia. A woman is at more than the
usual risk of thrombus formation postoperatively due to the increased
coagulation process accompanying pregnancy. Cervical conization for
cervical cancer has a particularly high fetal risk because the surgery may
directly disrupt the pregnancy.
Discuss drug and substance use in 1st and 3rd trimester of pregnancy
1st trimester
Some data show a slight correlation between consumption of large doses of

ASA during the first 16 weeks of pregnancy and the incidence of fetal
malforma- tions. If taken regularly during the last trimester, it may contribute
to prolonged gestation, prolonged labour, and increased maternal blood loss
during delivery. There is no evidence, however, that occasional use of small
doses of ASA during pregnancy is harmful. The administration of NSAIDs
should be terminated toward the last trimester to avoid premature closure of
the ductus arteriosus and postpartum bleeding. ASA is excreted in breast
milk, which may sensitize the infant to NSAIDs.

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Risk factors in high Risk pregnancy

Because their own development is still immature, adolescents are prone to

Young adolescents are more prone to postpartum hemorrhage than the

Inability to adapt postpartally

The immediate postpartum period may be an almost unreal time for an

Lack of knowledge About Infant Care

Cancer and Pregnancy

Although immuno- logic mechanisms are altered during pregnancy, there is

Some data show a slight correlation between consumption of large doses of

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