Summary

A high-risk pregnancy is one in which the pregnant person and fetus are at increased risk for adverse health outcomes during pregnancy. Extremes in maternal age place a pregnancy at risk, so preconception and pregnancy management should be tailored to individual patient age and health status. Nutritional imbalances from overnutrition or undernutrition require specific nutritional interventions and monitoring during preconception and pregnancy to prevent anemia and other complications. Certain conditions, such as migrant farm work, undocumented immigration status, substance misuse, and homelessness require specialized management and psychosocial support. Preexisting medical conditions, such as hypertension, diabetes, and thyroid disorders, should be managed closely prior to and after conception with an interdisciplinary care team. The nurse provides education about health concerns and treatment regimens, encourages compliance with ordered medications and tests, coordinates access to social services or specialist care, and supports patients dealing with the stress of a high-risk pregnancy.

The physiologic changes that occur during pregnancy can lead to complications that impair maternal-fetal health. The first trimester is a critical time for fetal development, so conditions that develop during this period can significantly compromise fetal health. Abortions and pregnancy loss more commonly occur during the first trimester as well. During the first trimester, patients begin to experience early signs of pregnancy and will often attend their first prenatal visit. This prenatal visit is critical for the evaluation of maternal-fetal health and sets the stage for care during pregnancy.

As the fetus and uterus continue to grow, the pregnant person’s body accommodates the additional physiologic changes that take place during the second trimester. Complications such as cervical insufficiency and preterm labor can lead to early deliveries and adverse outcomes. Patients who are at high risk for complications will be monitored closely with more frequent prenatal visits and serial diagnostic tests. The fetus grows the fastest during the third trimester as the patient’s body prepares for labor. Patients should be monitored closely for signs of fetal distress, preterm labor, preeclampsia, hemorrhage, and other complications. Early detection and prompt management of these conditions can decrease the risk of adverse outcomes for both the pregnant person and the fetus.

Nurses play a key role in monitoring the pregnant person and fetus in antepartum units and in clinics and private practice. Nurses perform nonstress tests (NSTs) and analyze fetal monitor strips, educate the pregnant person on the importance of fetal movement counts, and provide supportive care to decrease the stress of a high-risk pregnancy.