GUIDELINES FOR "HIGH RISK MOTHER"
The mother who visits obstetric clinic for her first pregnancy has a whole encyclopedia of questions and the age-old line "All will be fine" will not comfort her. Hence some guidelines are given below.

High Risk Mother
1.  Pregnancy in adolescence and teens.
2.  High blood pressure in pregnancy.
3.  Diabetes in pregnancy.
4.  Premature labour. Less than 34 weeks pregnancy.
5.  Previous pregnancy leading to premature delivery.
6.  Abnormal position and presentation of baby in uterus viz Breech.
7.  Prolonged labour especially on oxytocin (for about 8 hours).
8.  Unexpected bleeding in pregnancy.
9.  Poor foetal growth in II part of pregnancy.
10.Decreased movements of baby perceived by mother contrary to
     usual movement pattern. (VERY IMPORTANT)
11.Twin or Multiple pregnancy.
12.Suspected abnormality in baby by scan.
13.Mothers having heart, kidney, lung disease.
14.Mothers with weight less than 45kg and older than 35 years.
15.Mothers with haemoglobin less than 7gm%.
16.Inadequate weight gain during pregnancy.
17.Bad obstetric history. Previous abortions, still birth etc.
18.Maternal drug intake, alcohol, smoking etc.
19.Suspected intrauterine infection in mother (TORCH).
20.Pregnancy order exceeding 5.

These high-risk mothers should be referred to a good perinatal center where facilities for level III neonatal care (ventilator care) are available. The positive note on this strategy is that if all high risk mothers were transported to good neonatal centers. Only about 25% of such mothers would genuinely require extraordinary neonatal care (level III care). Another observation of grave significance is that even in 30% or more of so called "normal" pregnancies could become "high risk" in labour. Hence CTG monitoring is a must in all pregnancies ideally.

Hence all mothers could essentially expect 3 basic questions to be answered by the turn of the century.1.    Does the maternity hospital have adequate electronic surveillance, CTG monitoring, biophysical profile, Doppler flow of placenta etc by experienced doctors? 2.    Does the hospital have a paediatrician to attend delivery? The timing of first breath of the baby is critical to the baby's brain. If the baby does not get artificial respiration within one minute or so of delivery, if he does not breathe, the developing brain of the baby could be irreversibly damaged (ASPHYXIA) due to lack of oxygen to his brain. 3.    Does the maternity hospital have a neonatologist trained in high risk pregnancy? If so, does it have ventilatory assistance to be given if required to a high-risk newborn baby? Transferring a sick baby could have deleterious influence on the baby's brain and life.