High-Risk Pregnancy and Obstetric Complications
Core concepts
High-risk pregnancy requires identifying conditions that threaten mother or fetus: hypertensive disorders (chronic hypertension, gestational hypertension, preeclampsia, eclampsia), gestational diabetes, placenta previa and abruption, multiple gestation, preterm labor and preterm rupture of membranes, intrauterine growth restriction, isoimmunization, and infection (including syphilis and HIV).
Preeclampsia
Understand diagnostic criteria: new hypertension after 20 weeks with proteinuria or end-organ dysfunction (thrombocytopenia, renal insufficiency, liver involvement, pulmonary edema, visual or cerebral symptoms). Severe features demand urgent referral. Magnesium sulfate is used for seizure prophylaxis and treatment.
Bleeding in pregnancy
Distinguish antepartum bleeding causes: placenta previa (painless, bright red) versus abruption (painful, dark, board-like uterus). Never perform a digital vaginal examination in suspected previa.
Diabetes and growth
Know screening timing, glycemic targets, and the risks of macrosomia and neonatal hypoglycemia. Recognize that poor fundal height growth may signal growth restriction.
Traps
Gestational hypertension without proteinuria is not preeclampsia unless end-organ features are present. A single high blood pressure reading is not a diagnosis - repeat after rest. Preterm rupture of membranes requires avoidance of vaginal exams unless necessary and prompt referral.
Rule of thumb
Painless bleeding in late pregnancy = suspect previa, no vaginal exam. Painful bleeding with a hard uterus = suspect abruption, refer immediately.