Maternal and Fetal Risk Assessment

What is maternal and fetal risk assessment?

When your healthcare provider does a fetal risk assessment, he or she will ask you many questions about your medical, family, and pregnancy history. You will also have a physical exam. The information helps your provider know what problems, if any, may occur during your pregnancy. Your provider can then plan the care that you will probably need during the pregnancy.

It is best to have a risk assessment before you get pregnant. It may also be done at the first checkup of your pregnancy. There are different risk factors depending on your age, ethnic background, family history, job, where you live, and so on. If certain risks are found, there may be things you can do to reduce the risks.

What information is needed?

At your first visit, your healthcare provider may confirm your pregnancy with a urine or blood test. He or she will ask questions about your medical history, your menstrual periods, and any past pregnancies you have had. You will have a physical exam, including a pelvic exam with a Pap test, and culture tests to check for infections. The exam will give your provider more information about your health and will help determine when you became pregnant.

Your healthcare provider will gather the following information to help determine risks:

• History of current pregnancy:
  • What was the date of the first day of your last menstrual period?
  • Have you had any bleeding or spotting since then?
  • Have you had any cramping or pain?
  • Have you had a pregnancy test that confirmed that you are pregnant? If so, when?
  • Have you felt the baby move?
  • What are your feelings and the father's feelings about the pregnancy?
• History of previous pregnancies:
  • Have you been pregnant before? If so, how many times?
  • How many living children do you have?
  • Have you had any miscarriages and if so, how far along were you when you miscarried?
  • Have you had any terminations of pregnancies (also called TOPs or abortions) and if so, how far along were you when you had them? What method was used?
  • Did your past pregnancies or deliveries have any complications?
  • Were any of your past deliveries premature? How much did the baby weigh?
  • Were your babies healthy at birth? Did they have any problems?
  • Have you breast-fed in the past?
  • Did you have any complications after previous births?
  • Did you have a cesarean section?
  • Did you attend prenatal classes in the past, or do you plan to attend prenatal classes during this pregnancy?
• Gynecologic history:
  • How old were you when you began menstruating?
  • How many days are there between your menstrual periods? How many days do your periods last?
  • Have you used birth control pills?
  • Have you used pills to help you become pregnant?
  • Have you previously used any other form of birth control?
  • Are your menstrual periods painful?
  • Have you had any vaginal infections?
  • Have you had pelvic or vaginal surgery?
  • Have you had any abnormal Pap test results?
  • Have you had any treatment for abnormal Pap tests?
  • Have you been treated for a sexually transmitted disease?
• Medical history:
  • Do you have any allergies?
  • Do you take any medicines?
  • Have you had any viral infections recently?
  • Are you up to date on your shots?
  • Have you had any X-rays recently?
  • Have you had any diseases of the lungs, heart, nervous system, stomach, intestines, kidneys, thyroid gland, or pancreas?
  • Have you had any surgery?
  • Have you had any bleeding problems or blood transfusions?
  • Have you had any serious accidents?
  • Have you ever had a blood clot in your legs or lungs?
  • Do you smoke? If so, how much?
  • Do you drink alcohol?
• Social history:
  • Do you or the baby's father use drugs, such as cocaine, heroin, methadone, marijuana, amphetamines, or barbiturates?
  • How much do you exercise?
  • What is your situation at home? Where do you live and do you live with the baby's father?
  • Do you have any financial problems?
  • What kind of work do you do? Are you exposed to chemicals or radiation when you work?
  • Is there a problem with domestic violence or abuse?
• Family history (your family and the baby's father's family):
  • Does anybody in the family have high blood pressure, diabetes, or blood problems?
  • Has anyone in the family had twins?
  • Are there any birth defects in the family?
  • Is anyone in the family mentally retarded?
  • Did your mother take DES when she was pregnant with you?
  • Did your mother have high blood pressure in any of her pregnancies?
• Dietary history:
  • How many meals do you eat each day?
  • Do you follow any special diets?
  • Do you take any vitamins?
  • Have you had to follow a special diet in a previous pregnancy?
  • Do you have any unusual cravings?
  • Have you ever had an eating disorder, such as bulimia or anorexia?

What are some of the risk factors that might be discovered?

If you have one or more risk factors, it means that there is a greater than average chance that certain problems may happen during the pregnancy or delivery of the baby. The following list gives examples of risk factors and the high-risk conditions they may cause:

• If you had preterm labor or delivery during a previous pregnancy, you are at risk of having premature labor in your current pregnancy.
• If you are overweight, have a family history of diabetes, or had diabetes during a previous pregnancy, you are at risk of having diabetes during your current pregnancy.
• If you have kidney disease, are over 35 years old, have high blood pressure, or had toxemia during a previous pregnancy, you are at risk of having toxemia during your current pregnancy. Toxemia is a problem caused by high blood pressure during pregnancy.
• If you are over 35 years old, already had a baby with an abnormality, or have a family history of genetic abnormalities, you have an increased risk of having a baby with a chromosomal abnormality. The most common chromosomal abnormality is Down's syndrome.
• If you smoke, drink alcohol, or take illegal drugs, there is an increased risk for the baby both before and after the baby is born. These risks include premature birth and the baby having a drug or alcohol dependence. A substance abuse program can help you deliver a healthy baby.

These questions and examples are only some of the information required to assess possible complications of pregnancy. Depending on your answers and exam results, there may be other questions, exams, or tests.