N2 · High-risk pregnancy
Risk Maternal and newborn
Definition
Pregnancy conditions that raise the chance of harm to mother or baby.- Age
- diabetes
- high blood pressure
- twins
- past complications
- Abnormal scans or tests
- bleeding
- severe headache
- reduced baby movement
📋 Scenario
A 36-year-old woman with twins and diabetes attends a routine antenatal visit.
Subjective (S): "I am worried about my pregnancy because of my age."
Objective (O): Age 36; twin pregnancy; gestational diabetes; blood pressure 128/80; no protein in urine; no headaches.
Assessment tools for this scenario: CP-MOTHER Mother & Newborn Check CP-SKIN Skin & Wound Score CP-ELIM Elimination Check
Validated scales to consider: MEOWS, APGAR, Braden Scale, TIME wound chart, Bristol Stool Chart, bladder scan
**CarePath diagnosis:** High-risk pregnancy related to age, twins and diabetes (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Arrange regular visits. | Regular visits allow early detection of changes in blood pressure, blood sugar or the growth of the twins before they cause harm. |
| Monitor vital signs and baby movement. | Vital signs and baby movement are key indicators of her health and the babies' wellbeing, and a change can be the first sign of trouble. |
| Teach warning signs. | Knowing warning signs such as bleeding, severe headache or reduced movement helps her seek help at once instead of waiting. |
| Refer early. | Early referral to a specialist team means complications are handled sooner, which improves outcomes for the mother and both babies. |
**Expected outcomes**
- Blood pressure and tests stay in a safe range.
- Attends visits.
- Reports warning signs promptly.
- No complications.
**Linking the data to the diagnosis**
The 36-year-old woman with twins and gestational diabetes says, "I am worried about my pregnancy because of my age." Her blood pressure is 128/80, there is no protein in her urine and she has no headaches, so no complication has occurred. This is a risk diagnosis because age, a twin pregnancy and diabetes raise the chance of harm, but the harm is not present yet. An actual problem would need abnormal findings. The plan aims for blood pressure and tests to stay in a safe range, for her to attend visits, to report warning signs promptly and to avoid complications.
CarePath diagnosis
High-risk pregnancy related to age, twins and diabetes (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Arrange regular visits. | Regular visits allow early detection of changes in blood pressure, blood sugar or the growth of the twins before they cause harm. |
| 2. Monitor vital signs and baby movement. | Vital signs and baby movement are key indicators of her health and the babies' wellbeing, and a change can be the first sign of trouble. |
| 3. Teach warning signs. | Knowing warning signs such as bleeding, severe headache or reduced movement helps her seek help at once instead of waiting. |
| 4. Refer early. | Early referral to a specialist team means complications are handled sooner, which improves outcomes for the mother and both babies. |
Expected outcomes
- Blood pressure and tests stay in a safe range.
- Attends visits.
- Reports warning signs promptly.
- No complications.
Linking the data to the diagnosis
The 36-year-old woman with twins and gestational diabetes says, "I am worried about my pregnancy because of my age." Her blood pressure is 128/80, there is no protein in her urine and she has no headaches, so no complication has occurred. This is a risk diagnosis because age, a twin pregnancy and diabetes raise the chance of harm, but the harm is not present yet. An actual problem would need abnormal findings. The plan aims for blood pressure and tests to stay in a safe range, for her to attend visits, to report warning signs promptly and to avoid complications.