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 your care during the pregnancy.

It is best to have a risk assessment before you get pregnant, but it may also be done at the first checkup of your pregnancy. There are many different risk factors. They depend on your age, medical history, 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 will confirm your pregnancy with a urine or blood test. He or she will ask about your medical history, your menstrual periods, and any past pregnancies. 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. Your provider and will try to determine when you got 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 early (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 (C-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 do your periods last? How many days are there between your menstrual periods?
  • Have you used birth control pills?
  • Have you used any other form of birth control?
  • Have you used pills to help you get pregnant?
  • Are your menstrual periods painful?
  • Have you had any vaginal infections?
  • Have you had any abnormal Pap tests?
  • 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 at your 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?
  • Does anyone in the family have a developmental disability?
  • 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?

Your healthcare provider may need other information as well to know what problems you might have during pregnancy. Depending on your answers and exam results, there may be other questions, exams, or tests.

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

If you have one or more risk factors, it means that there may be 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, then you are at risk of having early labor in your current pregnancy.
• If you smoke, drink alcohol, or take illegal drugs, then there is an increased risk for the baby both before and after the baby is born. The baby might be born too early or may not grow normally. Alcohol can also cause physical and mental birth defects.
• If you are overweight, have a family history of diabetes, or had diabetes during a previous pregnancy, then 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, then 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 a genetic problem, or have a family history of genetic problems, then you have an increased risk of having a baby with a genetic problem. The most common genetic problem is Down's syndrome.