Case Management of High Risk Pregnancy

High risk pregnancies can be difficult to care for due to the numerous factors involved: the health of the mother, the health of the child, and the decisions being made by the family, nursing and support staff, and the doctor. Each pregnancy has its own unique set of risks and mild discomforts such as weight gain, back pain and nausea. Fortunately, with proper care, 95% of these high risk pregnancies result in healthy babies. (UC Irvine Health, 2014).

Illustrate the population

High risk pregnancies can occur when the mother is too young, too old, weighs too much or too little, or suffers from an underlying condition such as heart disease, hypertension, high blood pressure, kidney problems, autoimmune disorders, STDs, diabetes or cancer. (U.S. National Library of Medicine, 2014) High risk situations can also arise during pregnancy, including gestational diabetes, Rh factor incompatibility, ectopic pregnancies, or other problems with the developing fetus. (Mayo Clinic, 2012) Obstetrics nurses, and to a lesser extent, gynecological, neonatal and pediatric nurses can all provide care when treating a high-risk pregnancy.

Evaluate the population (size, seriousness, special needs)

According to UC Irvine Health, as many as ten percent of all pregnancies are considered high risk (UC Irvine Health, 2014). A high risk pregnancy can potentially happen to any woman of childbearing age. Depending on the specific risks involved, high risk pregnancy can be potentially fatal for mother, child, or both, so it is a very serious women’s health issue. High risk pregnancies require special needs compared to routine pregnancies, including additional scans screenings and tests such as ultrasounds, blood and urine analysis, cordocentesis and amniocentesis. (U.S. National Library of Medicine, 2014) Nursing education may be required to advise patients on how to minimize current risk factors such as improper diet, drugs or medications and avoid significant future risks such as pre-term labor and low birth weight.

Why there should be a formal case management program

High risk pregnancy can benefit from a case management program because properly sequenced and coordinated care will provide better for the mental and physical wellbeing of the mother, as well as the safety of the unborn child. It is important to follow the four steps of effective case management: Assessment, Planning, Facilitating, and Advocating (Powell, 2008). In a high risk pregnancy, complications can arise at any time, so continuity of care is extremely important. Nurses must be ready to engage with other members of the healthcare team at a moment’s notice in order to protect the woman and child’s health, whether this means calling a doctor or specialist during labor or arranging for support services after delivery.

The potential benefits of implementing a systematic case management plan

Systematic case management is well-suited to caring for high risk pregnancies because it minimizes costs through delegated responsibilities and efficient staffing while simultaneously providing increased quality of life and better patient outcomes. (Powell, 2008) Social disruption can be an important factor in high risk pregnancies, as family members desire to take an active role in the care of their expectant mother. Case management can allay families’ fears and make patients feel secure being their own advocate for proper medical care. (Powell, 2008)

Analyzes why nursing should coordinate this plan of care.

Due to the nature of nursing care, nurses have the best access to patient information and needs and consistently act as patient advocates and facilitators of treatment with respect to other members of the care team. Therefore, nursing should coordinate the plan of care for high risk pregnancies while interfacing directly with other medical staff. Nurses have the unique ability to continually assess, evaluate, propose nursing interventions and follow through on those interventions with evidence-based practice. Case management of high risk pregnancy entails a detailed history of the patient which is part of the nursing assessment and a watchful eye for any potential complications or side-effects from treatment.

Identify the other team members who should be included and why.

The supervision and support of a doctor, radiologist, ultrasound technician, anesthesiologist, and in some cases, midwife or doula, are essential to providing the highest quality of nursing care to patients with high risk pregnancies. Because the doctor supervises all medical care provided, his or her diagnosis and treatment plan form the backbone of case management. Ultrasound technicians provide essential screening for both healthy and high risk pregnancies which is interpreted by a radiologist. In addition to these extremely important team members, nurses can draw on the resources of a registered dietician, genetic counselor, or family planning specialist for additional help when faced with caring for a high risk pregnancy.  

References

Health Problems in Pregnancy: MedlinePlus. (2014, February 28). U.S National Library of Medicine. Retrieved February 28, 2014, from http://www.nlm.nih.gov/medlineplus/healthproblemsinpregnancy.html

Mayo Clinic. (2012, February 23). Pregnancy week by week. High-risk pregnancy: Know what to expect. Retrieved February 28, 2014, from http://www.mayoclinic.org/high-risk-pregnancy/ART-20047012?p=1

UC Irvine Health. (2014). High-Risk Pregnancy Services. Maternity Services. Retrieved February 28, 2014, from http://www.ucirvinehealth.org/medical-services/maternity/high-risk-pregnancy/

Powell, S. K., & Tahan, H. A. (2008). CMSA core curriculum for case management (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.