This study aims to analyze the factors associated with high-risk pregnancies due to Arterial Hypertension, as well as childbirth assistance in a highly complex public maternity, linked to the Rede Cegonha. This is an observational, cross-sectional study carried out in a maternity located in Fortaleza, Ceará, Brazil. Of the 300 participants, most have low socioeconomic conditions, living in a situation of vulnerability. There was an association between the variables age and parity, with statistical significance (p = <0.001), between education and first pregnancy (p = 0.002), between the age of the pregnant woman and the choice of motherhood (p = 0.03), as well as with the non-admission to the first maternity hospital that the pregnant woman sought care (p = 0.014). High-risk pregnant women, in a situation of social vulnerability, have access to prenatal care, even in the first trimester, but have difficulty accessing and wandering in search of childbirth assistance.