Maternal mortality remains a serious global health issue, with countless women losing their lives each year due to complications during pregnancy and childbirth. Despite notable progress in reducing pregnancy-related deaths, significant disparities persist—especially in low- and middle-income countries. In India, the National Health Mission estimates that 20–30% of pregnancies are classified as high-risk, contributing substantially to prenatal morbidity and mortality.1

Recent research highlights the vulnerability of specific demographics2. Uneducated women are twice as likely to experience high-risk pregnancies compared to their educated counterparts. Similarly, both the poorest and wealthiest economic groups are at increased risk. These findings underscore the influence of socioeconomic factors on maternal health outcomes. Reducing maternal deaths requires a multifaceted response—timely access to quality prenatal care, skilled birth attendance, and action on underlying risk factors such as education and economic status. Promoting healthy lifestyles and access to contraception are also vital components.

• Effective clinical care of high-risk pregnancies demands a proactive, comprehensive approach focused on early detection, risk stratification, and personalized interventions.
• Regular Prenatal Visits: Consistent prenatal care allows healthcare providers to monitor both maternal and fetal health, detect complications early, and intervene when necessary.
• Medical History and Physical Assessment: A thorough evaluation—including medical history, physical examination, and laboratory tests—is essential to identify pre-existing conditions (e.g., diabetes, hypertension, heart disease) and pregnancy-specific risks (e.g., multiple gestation, history of preterm birth).
• Medication Safety Review: All medications, including over-the-counter drugs and supplements, should be reviewed to ensure safety and adjust dosages as needed.
• Healthy Lifestyle Promotion: Patients should be encouraged to maintain a balanced diet, engage in safe physical activity, and avoid smoking, alcohol, and illicit drugs.
• Skilled Birth Attendance: Every birth should be attended by a trained healthcare provider capable of managing complications such as postpartum hemorrhage, infection (sepsis), preeclampsia/eclampsia, obstructed labor, and ectopic pregnancy.
• Postpartum Care: Follow-up care is crucial for monitoring the mother’s recovery and identifying issues such as infections, hemorrhage, or postpartum depression.
• Managing Specific High-Risk Conditions
• Preeclampsia and Eclampsia: Early detection and management are vital. WHO recommends low-dose aspirin for high-risk women3. Regular monitoring of blood pressure and urine analysis is essential. Magnesium sulfate is used to prevent seizures (eclampsia).
• Gestational Diabetes: Screening is essential. Management includes dietary changes, exercise, and, when needed, insulin therapy.
• Infection Prevention: Vaccinations (e.g., flu, Tdap), hygiene practices, and prompt treatment of infections can reduce risks during pregnancy.
• Hypertensive Disorders: Prevention and management of conditions such as preeclampsia and gestational hypertension are critical to maternal survival.
• Family Planning and Safe Abortion Access: Ensuring access to reproductive health services can reduce the number of unintended pregnancies and related complications.

• Family Planning Education: Educating women about reproductive health supports informed decisions about pregnancy spacing and contraception.
• Nutrition and Physical Activity: Encouraging healthy eating and moderate exercise during pregnancy supports maternal and fetal health.
• Avoidance of Harmful Substances: Preventing tobacco, alcohol, and drug use during pregnancy is essential for a safe and healthy gestation.

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Preventing maternal deaths demands collective action by healthcare professionals, policymakers, and communities. By emphasizing early identification and management of high-risk pregnancies, ensuring access to quality care, and addressing the root socioeconomic causes, we can dramatically improve maternal health outcomes. Findings from the NFHS-5 survey underscore the urgent need for targeted interventions to protect and promote the well-being of pregnant women in India and worldwide.

- By Dr. Manjula NV, Consultant - Department of Obstetrics and Gynecology, Ramaiah Memorial Hospital