Antenatal monitoring of the high risk fetus.
Fetus may be at high risk of perinatal mortality or morbidity or childhood morbidity either due to congenital malformations, genetically inherited disorders, chromosomal aberrations or due to antenatal and/or intrapartum hypoxia. Environmental hazards of infection, radiation and drug ingestion or maternal medical disorders are associated with some risk to the fetus. So it is important to identify those at risk by obtaining a detailed medical and family history. Maternal age and past obstetric history would also suggest the high risk nature of the pregnancy. A detailed clinical examination of the mother and the pregnancy will add further information. It is equally known that patients with no risk factors prior to pregnancy become at risk if they develop obstetric disorders of antepartum haemorrhage, pregnancy induced hypertension or diabetes. Therefore not only initial surveillance but continued care is important to identify those at risk. It is good practice to rule out congenital malformations, recognise multiple pregnancy and determine the gestational age in the early second trimester (18-21 weeks) by an ultrasound scan. This is of value in giving optimal care when a pregnancy turns from low to high risk. Aspects of monitoring the high risk fetus by simple clinical means and by appropriate technology is discussed.
Arulkumaran
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D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005315:Fetal Diseases / Q000175:diagnosis*; D005323:Fetal Monitoring; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D012307:Risk Factors; D014463:Ultrasonography