(2) High Risk Pregnancy

Dx: Uterine size may exceed gestational dating by 3 or more weeks.
Rx: Pre-eclampsia, premature birth, (50% twins, 90% triplets, 10% normal), low birth weight, and an increased risk of cerebral palsy. Mothers are more likely to receive a caesarean. There may be uterine atony and post partum haemorrhage.
Mng: Indication is for regular testing, beginning at 32 weeks.

Higher incidence in early pregnancy (40% at 20 weeks) but only 3-4% at term. Head tends to gravitate to the fundus in later pregnancy. Frank breech is most common, flexed at hips but extended at knees, buttocks are presenting part. Complete breech, hips + knees flexed, bottucks, genitalia and feet present.
Aet: Predisposing conditions include contracted pelvis, uterine anomalies (previous c-sec), fibroid uterus, placenta previa, multiple pregnancy, poly/oligohydraminos, and fetal abnormalities. USS may diagnose cause.
Dx: Antenatal. Mother may present with pain under ribs. Lie is longitundinal, head can be balloted in fundus. Ultrasound Ddx.
Rx: Cord prolapse (as dilated cervix is not filled), head entrapment in mid cervix during delivery, and cord compression during delivery resulting in oxygen deprivation.
Mng: C-sec indicated in UK and USA. Lower risk to foetus vs slightly higher risk to mother.

Pregnancy > 42weeks from first day of LMP. Dates of LMP may be inaccurate, and women may have irregular periods. Estimated date of delivery should be established as accurately as possible in early pregnancy (e.g. with USS).
Rx: Association with increased fetal mortality and morbidity. Typical complications include chronic meconium in utero aspiration leading to pneumonitis, and post maturity syndrome of infants with signs of interuterine malnutrition: no vernix caseosa or lanugo hair, abundant scalp hair and long fingernails, dry skin, long relative length and meconium staining. Risk of birth injury increased (related to macrosomia), and growth restriction leading to hypothermia and hypoglycaeia. Independant risk for CP and SIDS.
Mng: Offer of induction at 41 weeks. Twice weekly CTG if declined. Induction at start of 43rd week.