What is considered a high risk pregnancy?
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A pregnancy at risk for serious complications is considered to be a high risk pregnancy.  A high risk pregnancy may be identified by using a scoring system such as the system developed by Hobel et al . [1]  Risk factors are assigned a score corresponding to the degree of risk. A score of 10 or more indicates a high risk pregnancy that should receive more than routine prenatal care. The table below is a modification of Hobel et al's scoring system. 

OB History Risk Factor Points
Previous stillbirth 10
Previous neonatal death 10
Previous premature infant 10
Post-term > 42 weeks 10
Fetal blood transfusion for hemolytic disease 10
Repeated miscarriages 5
Previous infant > 10 pounds 5
Six or more completed pregnancies 5
History of eclampsia 5
Previous cesarean section 5
History of preeclampsia 1
History of fetus with anomalies 1
Medical History Risk Factor Points
Abnormal PAP test 10
Chronic hypertension 10
Heart disease  NYHA Class II-IV (symptomatic) 10
Insulin dependent  diabetes (> A2) 10
Moderate to severe renal disease 10
Previous endocrine ablation 10
Sickle cell disease 10
Epilepsy 5
Heart disease  NYHA  Class I  (no symptoms) 5
History of TB or PPD >= 10 mm 5
Positive serology (for syphilis) 5
Pulmonary disease 5
Thyroid disease 5
Family History Points
Family history of diabetes 1
Physical Risk Factor Risk Factor Points
Incompetent cervix 10
Uterine malformations 10
Maternal age 35 and over or 15 and under 5
Maternal weight < 100 pounds or > 200 pounds 5
Small pelvis 5
Current Pregnancy Risk Factor Points
Abnormal fetal position 10
Moderate to severe preeclampsia 10
Multiple pregnancy 10
Placenta abruptio 10
Placenta previa 10
Polyhydramnios or oligohydramnios 10
Excessive use of drugs/alcohol 5
Gestational diabetes (A1) 5
Kidney infection 5
Mild preeclampsia 5
Rh sensitization only 5
Severe anemia < 9 g/dL hemoglobin 5
Severe flu syndrome or viral disease 5
Vaginal spotting 5
Bladder infection 1
Emotional problems 1
Mild anemia 9 g/dL hemoglobin 1
Moderate alcohol use 1
Smoking >= 1 pack per day 1


1. Hobel CJ, Hyvarinen MA et al. Prenatal and intrapartum high-risk screening. Am J Obstet Gynecol. 1973; 117: 1-9. PMID: 4722373


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