الفهرس 
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Abstract
Pregnancy is a special event in women’s lives and indeed in the lives of their families. It is a unique experience that highlights their amazing creative and nurturing feminine powers and provides a bridge to their maternal future. Complications can occur anytime during the course of pregnancy and childbirth, which in turn can affect the health and the overall survival of the mother and her fetus. The World Health Organization (WHO) has reported that almost 830 women die daily as a result of complications during antenatal period and childbirth.
Five main domains may put the pregnant women at risk. Specifically, personal domain, previous pregnancies complications, previous deliveries complications, previous post-partum complications and the profile of present pregnancy. Hence, all pregnancies need to be evaluated for high-risk pregnancy through routine antenatal care provided by the health-care professionals.
Aim of the study
This study aimed to identify the profile of high risk pregnancy in Damanhur city.
Materials and Method
Research Design
A descriptive exploratory research design was utilized in this study.
Setting:
The study was conducted at the following settings to represent Damanhur city:
A. The antenatal clinic in Damanhur Medical National Institute (D.M.N.I). This Institute was purposefully selected because it represents the main health sector that provides antenatal care for Damanhur population as well as adjacent provisions.
B. The three available maternity and child health centers (MCH) in Damanhur city. Namely: Elhelal ELKadem MCH center, Shoubra MCH center and Abou Abdellah MCH center.
Subjects:
- A convenience sample of 250 pregnant women attending the previously mentioned settings was proportionally allocated according to each setting’s turnover rate.
Tools:
Two tools were used for data collection:
Tool I: pregnant women’s basic data structured interview schedule:
This tool was developed by the researcher. It entailed three sections:
- Socio-demographic characteristics such as: age, level of education and occupation. In addition to their marital status, current residence, family type, perceived income and consanguinity.
Reproductive history such as: number and sex of Living children as well as the interval between present pregnancy and previous delivery.
- History of present pregnancy such as: Gestational age (weeks), Sex of expected child and pattern of antenatal visits.
Tool II: pregnancy risk inventory score:
This tool was translated and adapted from three other tools: Morrison &Olsen, 1979, Dutta& Das, 1990 and foxcroft k, callaway L &Humphrey M, 2014. It was used to identify the profile of risk pregnancy among the study subjects.
Total items are 36 divided into:
- 1 item for age.
- 18 items for reproductive history such as gravidity, parity, abortion……etc.
- 8 items for history of present pregnancy such as bleeding, hypertensive disorders …etc.
- 8 items for associated medical conditions such as diabetes mellitus, heart disease…..etc.
- 1 item for body mass index.
According to each subject’s total score; she was categorized into three levels of risk:
Low risk : 0-2
Moderate risk : 3-5
High risk : ≥ 6
The main findings of the present study were:
- As much as 75.2% of the study subjects had a high risk pregnancy, compared to 20% who had moderate risk pregnancy, while only 4.8% had low risk pregnancy.
Personal domain:
- Among the high risk group more than one- half (58%) of them were in their twenties.
- Slightly less than one -quarter (23.4%) of them were less than 20 or more than 35 years old.
- About two-fifths (36.7%, 43.6%) were either overweight or obese, respectively.
Previous pregnancies domain:
- Among the high risk group more than one-half (58.5) of them were multigravida .while about one –third (30.9%) were primi-gravida and only 10.6% were grand multigravida.
- Slightly less than three quarters (72.3%) of high risk group had complications in previous pregnancy.
Previous deliveries domain:
- About two-thirds (63.3%) of the high risk group were multipara compared to about one-third (35.6%) who were nulliparous
- Slightly more than three-quarters (76%) of high risk group had previous cesarean section deliveries. while about one- quarter (24%) had previous normal delivery.
Previous post-partum domain:
- Slightly less than two-thirds (62.6%) among the high risk group had no previous postpartum complications .while a minority (3.4% and 4.0%) of them had either postpartum hemorrhage or Puerperal sepsis, respectively.
Present pregnancy domain:
- Approximately three- quarters (71.3%) of high risk group had present pregnancy complications such as bleeding, hypertension and anemia.
Factors associated with high risk pregnancy
- No statistically significant correlation was present between the study subjects’ risk level and level of educations, job, marital status, current residence, family type, family income and consanguinity.
- A statistically significant correlation is obvious among the study subjects risk level between the study subject’s number of living children, sex of living children, interval between present pregnancy and previous delivery and their risk level.
- No statistically significant correlation was observed between subjects risk level and gestational age (weeks), Sex of fetus and antenatal visit.
Recommendations
Based on the findings of the present study, the following recommendations are suggested:
1. A proper screening technique is recommended for all pregnant women attending antenatal clinics to identify factors that put them at risk.
2. Health education sessions are suggested for all pregnant women to emphasize the importance of compliance with antenatal check-ups.
3. A specialized antenatal clinic for high risky pregnancy is recommended in all maternity and child health centers (MCH).
4. In-service training for antenatal nurse about high risk pregnancy is recommended.
5. Expansion of the antenatal assessment sheet to include a section about assessment of risk level.
6. A special attention should be given to pregnant women’s personal risk domains.
7. Replication of the same study in other cities as well as villages in both upper and lower Egypt are recommended to identify the profile of high risk pregnancy in Egypt. Such a profile would gear the national services to decrease maternal morbidity and mortality.