International Journal of Midwifery Nursing And Practices Original Research
A Study on High-Risk Pregnancy and Its Management: Role of Obstetric Nurses in Improving Maternal and Fetal Outcomes
Abstract
High-risk pregnancy is a major challenge in maternal and neonatal healthcare and is associated with increased morbidity and mortality among mothers and new-borns, particularly in developing regions where access to quality healthcare services remains uneven, this article examines the concept, classification, risk factors, pathophysiology, and management of high-risk pregnancy with a strong focus on the role of obstetric nurses in improving maternal and fetal outcomes, obstetric nurses play a central role in early identification of complications, continuous monitoring, implementation of evidence-based interventions, and patient education across antenatal, intrapartum, and postnatal periods, nurse-led care has been shown to reduce complications such as preeclampsia, gestational diabetes, preterm birth, and postpartum hemorrhage while improving patient satisfaction and adherence to treatment, despite advancements in maternal healthcare, challenges such as inadequate training, high workload, and limited resources continue to affect nursing effectiveness, therefore strengthening nursing education, promoting skill-based training, and ensuring institutional support are essential for optimizing outcomes, this article highlights the importance of empowering obstetric nurses and integrating their role into maternal healthcare systems to achieve better clinical outcomes and reduce maternal and neonatal mortality.
Keywords
References (40)
- American Academy of Pediatrics. (2018). Neonatal care guidelines. Pediatrics, 142(1), e20181031. Available at: https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/blz-mn-32-02-guideline-2018-eng-neonatal-clinical-guidelines-2018-2021.pdf
- Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology. 2020;135(6):e237-e260. doi:10.1097/aog.0000000000003891
- American Diabetes Association. 2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2021. Diabetes Care. 2020;44(Supplement_1):S15-S33. doi:10.2337/dc21-s002
- TIKKANEN M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstetricia et Gynecologica Scandinavica. 2010;90(2):140-149. doi:10.1111/j.1600-0412.2010.01030.x
- Ayres-de-Campos D. Electronic fetal monitoring or cardiotocography, 50 years later: what's in a name? American Journal of Obstetrics and Gynecology. 2018;218(6):545-546. doi:10.1016/j.ajog.2018.03.011
- Baschat AA. Fetal responses to placental insufficiency: an update. BJOG. 2004 Oct;111(10):1031–41. doi:10.1111/j.1471–0528.2004.00273.x. PMID: 15383103.
- Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLOS Medicine. 2015;12(6):e1001847. doi:10.1371/journal.pmed.1001847
- Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive Disorders of Pregnancy. Hypertension. 2018;72(1):24-43. doi:10.1161/hypertensionaha.117.10803
- Cao C, Saxena R, Gray KJ. Placental Origins of Preeclampsia: Insights from Multi-Omic Studies. International Journal of Molecular Sciences. 2024;25(17):9343. doi:10.3390/ijms25179343
- Campbell OM, Graham WJ; Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006 Oct 7;368(9543):1284–99. doi:10.1016/S0140–6736(06)69381–1. PMID: 17027735.
- Catalano PM. Obesity, insulin resistance, and pregnancy outcome. Reproduction. 2010;140(3):365-371. doi:10.1530/rep-10-0088
- Salimbayeva D, Urazbayeva G, Kurmanova A, Smailov M, Nurmakova A. RNA biomarkers in hypertensive disorders of pregnancy: systematic review. J Perinat Med. 2025 Oct 17;54(3):467-480. doi:10.1515/jpm-2025–0143. PMID: 41100582.
- Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. The Lancet. 2006;368(9549):1810-1827. doi:10.1016/s0140-6736(06)69480-4
- Davenport MH, Marchand AA, Mottola MF, Poitras VJ, Gray CE, Jaramillo Garcia A, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine. 2018;53(2):90-98. doi:10.1136/bjsports-2018-099400
- Brown HL, DeNicola N. Telehealth in Maternity Care. Obstetrics and Gynecology Clinics of North America. 2020;47(3):497-502. doi:10.1016/j.ogc.2020.05.003
- Escañuela Sánchez T, Linehan L, O'Donoghue K, Byrne M, Meaney S. Facilitators and barriers to seeking and engaging with antenatal care in high‐income countries: A meta‐synthesis of qualitative research. Health & Social Care in the Community. 2022;30(6). doi:10.1111/hsc.14072
- Screening for pregnancy complications. BMJ. 2002 Jul 20;325(7356):0. PMCID: PMC1123649.
- Vallely LH, Shalit A, Nguyen R, Althabe F, Pingray V, Bonet M, et al. Intrapartum care measures and indicators for monitoring the implementation of WHO recommendations for a positive childbirth experience: a scoping review. BMJ Open. 2023;13(11):e069081. doi:10.1136/bmjopen-2022-069081
- Kamphof HD, Posthuma S, Gordijn SJ, Ganzevoort W. Fetal Growth Restriction: Mechanisms, Epidemiology, and Management. Maternal-Fetal Medicine. 2022;4(3):186-196. doi:10.1097/fm9.0000000000000161
- Dassie GA, Lemi H, Getachew T, Ayana S. Maternal diet quality during pregnancy and birth outcomes in low- and middle-income countries: a scoping review. BMC Nutrition. 2026;12(1). doi:10.1186/s40795-025-01229-5
- National Guideline Alliance (UK). Fetal movement monitoring: Antenatal care: Evidence review P. London: National Institute for Health and Care Excellence (NICE); 2021 Aug. (NICE Guideline, No. 201.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK573940/
- Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. 2017;2017(8). doi:10.1002/14651858.cd003766.pub6
- Keighley CL, Skrzypek HJ, Wilson A, Bonning MA, Gilbert GL. Infections in pregnancy. Medical Journal of Australia. 2019;211(3):134-141. doi:10.5694/mja2.50261
- Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196-e1252. doi:10.1016/s2214-109x(18)30386-3
- Xu J, Lin X, Fang Y, Cui J, Li Z, Yu F, et al. Lifestyle interventions to prevent adverse pregnancy outcomes in women at high risk for gestational diabetes mellitus: a randomized controlled trial. Frontiers in Immunology. 2023;14. doi:10.3389/fimmu.2023.1191184
- Lavender T, Hart A, Smyth RM. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database of Systematic Reviews. 2013. doi:10.1002/14651858.cd005461.pub4
- Chew LC, Osuchukwu OO, Reed DJ, et al. Fetal Growth Restriction. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562268/
- Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Audibert F, et al. The hypertensive disorders of pregnancy (29.3). Best Practice & Research Clinical Obstetrics & Gynaecology. 2015;29(5):643-657. doi:10.1016/j.bpobgyn.2015.04.001
- Yu C, Teoh T, Robinson S. Review article: Obesity in pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2006;113(10):1117-1125. doi:10.1111/j.1471-0528.2006.00991.x
- Murray SR, Reynolds RM. Short‐ and long‐term outcomes of gestational diabetes and its treatment on fetal development. Prenatal Diagnosis. 2020;40(9):1085-1091. doi:10.1002/pd.5768
- Menon R, Behnia F, Polettini J, Richardson LS. Novel pathways of inflammation in human fetal membranes associated with preterm birth and preterm pre-labor rupture of the membranes. Seminars in Immunopathology. 2020;42(4):431-450. doi:10.1007/s00281-020-00808-x
- James AH. Iron Deficiency Anemia in Pregnancy. Obstetrics & Gynecology. 2021;138(4):663-674. doi:10.1097/aog.0000000000004559
- Moller AB, Patten JH, Hanson C, Morgan A, Say L, Diaz T, et al. Monitoring maternal and newborn health outcomes globally: a brief history of key events and initiatives. Tropical Medicine & International Health. 2019;24(12):1342-1368. doi:10.1111/tmi.13313
- da Silva Lopes K, Ota E, Shakya P, Dagvadorj A, Balogun OO, Peña-Rosas JP, et al. Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews. BMJ Global Health. 2017;2(3):e000389. doi:10.1136/bmjgh-2017-000389
- Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends in Endocrinology & Metabolism. 2018;29(11):743-754. doi:10.1016/j.tem.2018.09.004
- Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019:l2381. doi:10.1136/bmj.l2381
- Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Kardiologia Polska. 2019;77(3):245-326. doi:10.5603/kp.2019.0049
- Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, et al. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet. 2014;384(9948):1129-1145. doi:10.1016/s0140-6736(14)60789-3
- Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? The Lancet. 2016;387(10017):491-504. doi:10.1016/s0140-6736(15)01044-2
- Hudić I, Stray-Pedersen B, Tomić V. Preterm Birth: Pathophysiology, Prevention, Diagnosis, and Treatment. BioMed Research International. 2015;2015:1-1. doi:10.1155/2015/417965