High-Risk Pregnancies and Their Outcomes in a Tertiary-Care Centre in South India

Abstract

Background: High-risk pregnancies (HRP) account for a disproportionate share of maternal and perinatal morbidity and mortality in low- and middle-income countries. India’s Maternal Mortality Ratio (MMR) has fallen to 97 / 100 000 live births in 2018–20, yet preventable deaths persist, particularly among women with multiple risk factors.

Methods: A prospective observational study was conducted in the Department of Obstetrics & Gynaecology, ESIC Medical College & PGIMSR, Bengaluru (January 2023 – January 2025). All singleton or multifetal HRP admissions (n = 1 250) were enrolled after informed consent. Risk factors were classified as demographic, medical, obstetric or fetal. Primary outcomes were maternal morbidity/mortality and neonatal morbidity/mortality up to day 7 postpartum. Data were analysed with descriptive statistics; categorical variables were expressed as frequencies and percentages.

Results: HRP constituted 33 % (1 250 / 3 780) of obstetric admissions. The commonest risk factors were thyroid disorders (36.1 %), previous caesarean (28.1 %), anaemia (22.9 %), liquor abnormalities (14.9 %) and hypertensive disorders (11.8 %). Overall caesarean rate was 53.7 % (671 / 1 250), predominantly for scarred uterus (51 %) and iatrogenic indications such as severe pre-eclampsia and fetal growth restriction. Maternal morbidity was 5.8 %; postpartum haemorrhage (1.7 %) and eclampsia (1.8 %) were leading complications. There were no maternal deaths. Neonatal admission rate was 19.1 %; jaundice (11.6 % of all neonates) and respiratory distress (2.2 %) predominated. Perinatal mortality was 0.8 % (intra-uterine death 0.24 %, neonatal death 0.56 %).

Conclusion: Although HRP burden remains high, multidisciplinary management in tertiary centres can achieve zero maternal deaths and low perinatal loss. Targeted interventions—early anaemia correction, thyroid screening, VBAC counselling and strict hypertensive surveillance—could further improve outcomes. Strengthening peripheral referral and continuity of antenatal care under initiatives such as PMSMA and e-PMSMA is imperative.