Women who have a greater chance of having a high-risk pregnancy can benefit most from counseling before pregnancy occurs. These women include elderly ladies, those with recurrent pregnancy loss, members of specific ethnic groups, those exposed to potentially teratogenic agents, patients with metabolic or genetic diseases, and those with an obstetric history of isoimmunization, previous cesarean section, or preterm delivery. Preconceptional counseling is an extension of prenatal care intended to minimize the maternal and fetal risk, to prevent birth defects, and to provide high-risk women with information about the risk and available options. Most of these options are viable only if the patient is aware of their availability before attempting conception.