Authored By: Dr. K. Shilpi Reddy

HOD & Sr. Consultant Obstetrician & Gynaecologist,

High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)


A pregnancy is a high-risk when there are potential complications that could affect the mother, the baby, or both. High-risk pregnancies require management by a specialist to ensure the best outcome for the mother and baby.


Risk Factors

Sometimes a high-risk pregnancy is due to a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy causes a pregnancy to become high risk.

Maternal Age One of the commonest risk factors is the age of the mother-to-be. Women who will be under age 17 or over age 35 are at greater risk. The risk of miscarriage and genetic defects increases further after age 40.

Pre Existing Medical conditions Conditions such as high blood pressure; lung, kidney, or heart problems; diabetesautoimmune diseasesexually transmitted diseases (STDs); or chronic infections such as human immunodeficiency virus (HIV) can be risky for the mother and/or their unborn baby. Previous history of miscarriage, problems with a previous pregnancy or pregnancies, or a family history of genetic disorders are also risk factors for a high-risk pregnancy.

Medical conditions that occur during pregnancy Two of the more common pregnancy-related problems are:

  •  Preeclampsia is a syndrome that includes high blood pressure, urinary protein, and swelling; it can be dangerous or even fatal for the mother or baby if not treated. With proper management, most women who develop preeclampsia have healthy babies.
  •  Gestational diabetes is when diabetes develops during pregnancy. Women with gestational diabetes may have healthy pregnancies and babies the treatment plan is been followed. Usually the diabetes resolves after delivery. Women with gestational diabetes are at increased risk of developing type 2 diabetes.
  • Pregnancy-related issues. Often a pregnancy is high risk because of issues that arise from the pregnancy itself and that have little to do with the mother’s health. These include:
  •  Premature labor is labor that begins before 37 weeks of pregnancy. Factors that place women at higher risk for Preterm labor- such as certain infections, a shortened cervix, or previous preterm birth.
  •  Multiple births means carrying more than one baby. Multiple pregnancies, are more common as women are using more infertility treatments, increase the risk of premature labor, gestational diabetes, and pregnancy-induced high blood pressure.
  •  Placenta previa is a condition in which the placenta covers the cervix. The condition can cause bleeding, especially if a woman has contractions.
  •  Fetal problems Approximately 2% to 3% of all babies have a minor or major structural problem in development.

Prevention

  • Schedule a preconception appointment. Before palnning for Pregnancy- start taking a daily prenatal vitamin with folic acid and reach a healthy weight. If you have a medical condition, treatment might be adjusted in preparation for pregnancy. Discuss all risk factors related to a genetic condition.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. You might require a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits.
  • Getting proper immunizations
  • Getting regular physical activity, unless advised otherwise by your doctor

Investigation

Specialized or targeted ultrasound might be required depending on condition. This is an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus — targets a suspected problem, such as abnormal development.

  • Prenatal cell-free DNA (cfDNA) screening-DNA from the mother and fetus is extracted from a maternal blood sample and the fetal DNA is screened for the increased chance of specific chromosome problems.
  • Invasive genetic screening. Amniocentesis or chorionic villus sampling (CVS). In amniocentesis, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Usually done after week 15 of pregnancy, amniocentesis can identify certain genetic conditions as well as serious abnormalities of the brain or spinal cord (neural tube defects). During CVS, a sample of cells is removed from the placenta. Mainly done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Ultrasound for cervical length to determine if you’re at risk of preterm labor.
  • Lab tests. Test your urine for urinary tract infections and screening for infectious diseases such as HIV and syphilis.
  • Biophysical profile. This prenatal ultrasound is used to check on a baby’s well-being. It might include only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss.Discuss the risks and benefits with your Doctor.

Red Flag signs

Contact your Doctor immediately if –

  • Vaginal bleeding or watery vaginal discharge
  • Severe headaches
  • Pain or cramping in the lower abdomen
  • Decreased fetal activity
  • Pain or burning with urination
  • Changes in vision, including blurred vision
  • Sudden or severe swelling in the face, hands or fingers
  • Fever or chills
  • Vomiting or persistent nausea
  • Dizziness
  • Thoughts of harming yourself or your baby

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