Pregnant women with high obstetrical risk
I. Circumstances psycho-social:
1. Unwanted pregnancy;
2. Unfavorable emotional climate, dysfunctional families;
3. Women residing in inaccessible geographic areas, without possibility of emergency transport;
4. Failure of legislation for the protection of women at work;
5. Iatrogenic: omissions, errors of interpretation of subtle pathology.
II. General factors:
1. Age: primiparous under 20 and over 35 years;
2. Parity – great multiparous;
3. Shorter than 1.55 m;
4. Weight below 45 kg;
5. Genital weakness;
6. Reduced cardiac volume;
7. Rh or group isoimmunization;
8. Autoimmune diseases.
III. Gynecological history:
1. Uterine scar;
2. Genital malformations or tumors;
3. Sterility treated;
4. Plastic surgery on the genital area or rectum;
5. Pregnancy with complications or childbirth at least 1 year of current fertilization;
6. Abortion, premature birth;
7. Births with mechanical dystocia, dynamic dystocia, hemorrhage during birth, interventions;
8. Confinement after birth with infectious syndrome or thromboembolic disease;
9. Birth of dead fetuses, dead fetuses during normal period, malformed children, macrosomia, disabled, weakness.
IV. Preexisting diseases:
1. Heart disease;
2. Arterial hypertension;
4. Endocrine, metabolism disorders, obesity, diabetes, hyperparathyroidism, hypo-or hyperthyroidism;
5. Respiratory diseases;
7. Chronic infection: tuberculosis, syphilis;
8. Infectious diseases: rubella, herpes, toxoplasmosis, listeriosis, hepatitis, colibacillosis, cytomegalovirus infection;
9. Chronic hepatitis;
10. Orthopedic Disorders: scoliosis, limping, stiffness.
5. Lead poisoning.
VI. Pregnancy complicated by:
1. Bone dystocia;
2. Dystocia of presentation (including breech presentation);
3. Abnormal increase in weight;
4. Eclamptic during the last quarter;
5. Urinary, vaginal, skin infections;
6. Abnormal growth of uterine volume;
7. Bleeding after 20 weeks;
8. Cervical incontinence;
9. False labor;
10. Rh incompatibility or group;
12. Diseases occurring during pregnancy;
13. Exploration of potential biological tests with poor values;
14. Outside of normal term pregnancy.
VII. Intranatal factors:
1. Recent bleeding;
2. Intercurrent disease in evolution;
3. Rupture of membranes for more than 6h, without triggering the uterine contractions;
4. Prolapsing cord;
5. Labor over 12 hours in multiparous and more than 24 h at primiparous;
6. Chemical suspicion of fetal distress;
7. Intrauterine death of the fetus.
Depending on these factors is calculated a risk score for women with low, medium and high risk.