Maternal Health

Signs of High-Risk Pregnancy You Shouldn’t Ignore

June 23, 2025
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Introduction

Pregnancy is often described as a miraculous journey—but it also comes with complex physical and emotional changes. For many women, pregnancy progresses smoothly. However, in some cases, complications arise that can put both the mother and fetus at serious risk. These are known as high-risk pregnancies.

In low- and middle-income countries, particularly in sub-Saharan Africa, high-risk pregnancies contribute significantly to maternal and perinatal mortality. Recognizing early danger signs can dramatically improve outcomes, especially where timely access to skilled care is limited. This guide aims to help mothers, families, and health workers identify, understand, and act on warning signs of pregnancy complications—before it’s too late.

What Is a High-Risk Pregnancy?

A high-risk pregnancy is one in which the mother, fetus, or both are at an increased risk of health complications before, during, or after delivery. High-risk pregnancies may arise from pre-existing conditions, pregnancy-related disorders, or socioeconomic and environmental factors. Early identification and proper management can significantly reduce adverse outcomes.

Common Risk Factors

Advanced maternal age (<17 or >35 years)
Chronic conditions (e.g., hypertension, diabetes, HIV, epilepsy)
Anemia and malnutrition
Previous miscarriage, stillbirth, or cesarean
Twin or multiple pregnancy
Short birth intervals (<18 months)
Lack of antenatal care (ANC)

In Africa, risk is often compounded by:

Inadequate access to emergency obstetric care (EmONC)
Weak referral systems
Gender inequality and cultural barriers

Why Early Warning Signs Matter

Complications during pregnancy often progress rapidly. In many cases, the earliest symptoms are subtle. Delays in recognizing and responding to danger signs account for a large proportion of preventable maternal deaths. According to the Three Delays Model, poor outcomes are often due to:

Delay in recognizing danger signs
Delay in reaching a health facility
Delay in receiving appropriate care

Empowering women and caregivers with awareness and education is essential to save lives.

⚠️ Top 10 Warning Signs of High-Risk Pregnancy You Should Never Ignore

1. Severe or Persistent Headaches

A constant or intense headache, especially in the second or third trimester, may be a symptom of preeclampsia, a hypertensive disorder that affects about 5–8% of pregnancies worldwide (American College of Obstetricians and Gynecologists [ACOG], 2022). It can lead to seizures, stroke, or death if untreated.

🩺 Seek urgent care if the headache is accompanied by visual changes, nausea, or swelling.

2. Blurred Vision, Seeing Spots, or Sudden Loss of Vision

Visual disturbances may also indicate severe preeclampsia or eclampsia, where dangerously high blood pressure damages blood vessels in the brain and eyes.

🔬 These symptoms require immediate hospitalization and magnesium sulfate therapy to prevent seizures.

3. Vaginal Bleeding

While light spotting can be normal early in pregnancy, heavy or bright red bleeding, especially with abdominal pain or clots, is a red flag.

Possible causes:

Miscarriage
Placenta previa (placenta covering the cervix)
Placental abruption (placenta separating from the uterus)
Ectopic pregnancy

📉 In Africa, hemorrhage accounts for 27% of maternal deaths (WHO, 2023).

4. Severe Abdominal or Pelvic Pain

Not all pain in pregnancy is normal. Persistent, sharp, or cramping pain may be caused by:

Ectopic pregnancy (life-threatening if rupture occurs)
Preterm labor
Uterine rupture (especially in women with prior cesarean)
Infection or appendicitis

📞 Immediate ultrasound and clinical evaluation are crucial.

5. Swelling of Face, Hands, or Generalized Edema

Sudden swelling—especially in the face or around the eyes—may signal preeclampsia.

🔍 Differentiate from mild, gradual swelling of ankles (which is often normal). Rapid weight gain (>2kg/week) is also concerning.

6. High Fever (Above 38°C / 100.4°F)

A sustained fever may indicate:

Urinary tract infection (UTI)
Chorioamnionitis (infection of the amniotic fluid)
Malaria, typhoid, or other systemic infections

🌍 In malaria-endemic regions, malaria in pregnancy increases the risk of miscarriage, anemia, and stillbirth.

7. Painful or Bloody Urination

Urinary infections are common in pregnancy due to hormonal changes and reduced bladder tone. Untreated UTIs can lead to:

Preterm labor
Kidney infections (pyelonephritis)
Sepsis

🔬 Routine ANC screening and antibiotics are effective prevention.

8. Reduced or No Fetal Movement (After 28 Weeks)

Most women begin to feel regular fetal movement by 20–24 weeks. By the third trimester, 10 kicks in 2 hours is considered reassuring.

❗ A decrease or absence in movement may indicate:

Fetal distress
Stillbirth
Intrauterine growth restriction (IUGR)

🩺 Urgent fetal monitoring or ultrasound is needed.

9. Preterm Labor (Before 37 Weeks)

Early contractions, pressure in the pelvis, and watery vaginal discharge may mean preterm labor is beginning.

🌍 Preterm birth is the leading cause of newborn death in Africa (UNICEF, 2022). Immediate intervention may include bed rest, steroids, and tocolytics.

10. Severe Vomiting (Hyperemesis Gravidarum)

Persistent vomiting leading to dehydration, weight loss, and electrolyte imbalance is dangerous for both mother and fetus.

💧 Hospitalization for IV fluids and medication is often required.

📈 Global and African Maternal Health Statistics

830 women die every day from preventable pregnancy-related causes (WHO, 2023).
94% of maternal deaths occur in low-resource settings, mostly in sub-Saharan Africa and South Asia.
In Nigeria and Ethiopia, more than 50% of women do not receive any skilled care during delivery.
Women in rural areas are 3–4 times more likely to die from pregnancy complications than those in urban settings.

🧠 Understanding the Clinical Pathways

Many of the complications mentioned (e.g., preeclampsia, eclampsia, sepsis) follow well-understood clinical pathways and respond to evidence-based interventions such as:

Magnesium sulfate for seizure prevention
Oxytocin and misoprostol for postpartum hemorrhage
Antibiotics and IV fluids for sepsis
Timely cesarean section for obstructed labor

However, early recognition and referral are the weak links in many African health systems.

🏥 When to Seek Emergency Medical Care

Seek immediate care if any of the following occur:

Heavy vaginal bleeding
Severe headache with blurred vision
No fetal movement for more than 12 hours
Fever with abdominal pain
Convulsions or unconsciousness

⏱️ Time is critical. Always aim to reach a facility with emergency obstetric and newborn care (EmONC).

📣 Call to Action for Stakeholders

For Mothers and Families:

Learn the danger signs and trust your instincts.
Attend all antenatal care (ANC) visits—at least 8 as per WHO guidelines.
Create a birth preparedness plan (transport, savings, blood donor, referral).

For Health Workers:

Provide clear counseling on high-risk signs during every ANC visit.
Use maternity cards and mobile tracking tools to monitor risk.
Strengthen referral protocols and communication with higher-level facilities.

For Policymakers and NGOs:

Train more midwives and skilled birth attendants.
Expand rural access to EmONC services.
Integrate maternal danger sign education into community outreach.

🧾 References (APA)

American College of Obstetricians and Gynecologists. (2022). Hypertension in Pregnancy: ACOG Practice Bulletin No. 222. https://www.acog.org

World Health Organization. (2023). Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

UNICEF. (2022). Maternal and Newborn Health. https://data.unicef.org/topic/maternal-health/

Kenya Ministry of Health. (2021). MPDSR Report: Maternal and Perinatal Death Surveillance and Response. https://www.health.go.ke

FIGO. (2019). Guidelines for Emergency Obstetric Care. https://www.figo.org/resources/guidelines

📚 Resources for Continued Learning

WHO – Emergency Obstetric and Newborn Care (EmONC)
https://www.who.int/health-topics/maternal-health
UNFPA – Maternal Health Toolkits
https://www.unfpa.org/maternal-health
PMNCH – Maternal Danger Sign Counseling Materials
https://www.who.int/pmnch
Mama Rescue (Uganda) Emergency Transport Service
https://path.org/resources/mama-rescue-app/