At-Risk Pregnancy Conditions
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Obstetric care providers are responsible for identifying high-risk pregnancy candidates and referring them to perinatal specialists, coordinating other medically necessary services, and making referrals to social services and community support agencies at any time during the pregnancy when high-risk indicators are identified.
The Health Net Medi-Cal Health Services Department is available to help coordinate services. The obstetric care provider supervises the member's individualized care plan (ICP) to ensure that risks are addressed by priority and that actions taken can be expected to ameliorate the conditions identified. This responsibility exists notwithstanding that the services may take place outside the provider's practice.
The following is a list of some of the risk factors, derived from the history or physical examination of the member, that may increase pregnancy risks and necessitate further evaluation, consultation or referral:
- Substance use
- HIV risk status
- Noncompliance with medical advice
- Failed appointments
- Age less than 17 or greater than 35
- Late initiation of prenatal care
- Primagravida or grand multipara
- Previous pregnancy problems
- Nutritional status indicators
- Occupational risk
- Diabetes
- Hypertension/pregnancy-induced hypertension
- Cardiovascular problems
- Hepatitis
- Tuberculosis
- Sexually transmitted disease (STD) history
- Uterine problems
- Kidney problems
- Pulmonary disease
- Epilepsy
- Hematologic disorders
- Preterm labor
- Eating disorders
- Mental disabilities
- Physical disabilities
- Inability to read or low reading level
- Language barriers
- Low educational level
- Low motivation
- Negative attitude about pregnancy
- Little or no prior experience with Western medicine/ health care
- Lack of social support structures
- Inability to reach decisions/comprehension difficulties
- Extreme anxiety or emotional problems
- Transportation challenges
- Family problems/abuse
- Economic/housing needs
- Informed consent needs
- Other children not linked to well-child care resources
- Lack of knowledge related to management of common pregnancy and postpartum-related conditions/discomforts
The following is a list of some of the nutritional risk factors, derived from the history or physical examination of the member, that may increase pregnancy risks and necessitate further evaluation, consultation or referral:
- Inadequate (less than two pounds per month after first trimester) or excessive (more than eight pounds per month) weight gain
- Eating disorders
- Tobacco, alcohol, drug, and caffeine use
- Hematocrit less than 27 percent
- Hemoglobin less than 9 percent
- MCV less than 83 or greater than 95 cu ml
- Abnormal three-hour glucose tolerance test
- Presence of glucose, ketones or protein in urine
- Pica
- No cold food storage or cooking facilities
- Less than three years since onset of menses
- High parity (five or more previous deliveries at greater than 20 weeks gestation)
- Excessive use of nutrient supplements
- Chronic use of laxatives, antacids or other over-the-counter medications known to affect nutritional status
- Use of herbal remedies known or suspected to cause toxic side effects
The following is a list of some of the factors, derived from the history or physical examination of the member, that may increase pregnancy risks and necessitate further evaluation, consultation or referral:
- Poor obstetric history
- Maternal age under 17 or over 35
- Previous congenital anomalies
- Multiple gestation
- Isoimmunization
- Intrauterine growth retardation
- Third-trimester bleeding
- Pregnancy-induced hypertension
- Uterine structural anomalies (for example, septum abnormality caused by in utero exposure to diethylstilbestrol)
- Abnormal amniotic fluid volume
- Fetal cardiac arrhythmias
- Prematurity
- Breech or transverse lie (intrapartum)
- Rupture of membranes for a period of time longer than 24 hours
- Chorioamnionitis
- Inadequate pregnancy interval
The following is a list of some of the factors, derived from the history or physical examination of the member, that may increase pregnancy risks and necessitate further evaluation, consultation or referral:
- Inadequate housing
- Domestic violence
- Absence of adequate psychosocial support
- Cognitive deficits
- Transportation needs
- Excessive worries and fears
- Previous pregnancy loss
- Severe emotional problems
- Eating disorders
- History of depression, suicidality, psychosis, or hospitalization
- Pregnancy complicated by detection of fetal anomaly
- Extreme difficulty or resistance to compliance with medical recommendations or restrictions
- Postpartum depression