High-risk pregnancy? Here’s what all you need to know

A pregnancy is considered high-risk when there are potential complications that could affect the mother, baby or both. These complications can arise any time before, during or after delivery. 

WHAT ARE THE RISK FACTORS? 

Pre-existing factors:  

A pre-existing heart condition. 

Hypertension, Asthma, Epilepsy, kidney diseases 

Obesity:  BMI of 30 or higher. 

TYPE 2 Diabetes 

Certain Sexually transmitted infections  including HIV 

Autoimmune diseases like SLE 

Blood disorders like sickle cell disease 

Family history of genetic diseases 

Age more than 35 or younger than 18  

Lifestyle factors: Smoking, drinking, or using drugs  

Complications in a previous pregnancy:  

Risk Factors Developed During Pregnancy : 

Preeclampsia: It is a serious blood pressure disorder that can affect all of the organ’s in a pregnant woman’s body. 

HELLP syndrome: This is a rare condition related to preeclampsia in which red blood cells are damaged or destroyed, which can cause the liver to bleed and clotting issues. 

Multiple pregnancy: Twins, triplets 

Gestational diabetes 

Placental complications like placenta previa, accreta, abruption which can cause severe bleeding. 

Preterm labor: Delivery before 37 weeks 

HOW TO IDENTIFY HIGH-RISK PREGNANCIES 

The best time to assess the potential impact of medical or obstetric complications on the outcome of pregnancy is before pregnancy occurs. This is known as pre conceptional counselling. This helps in identifying a significant number of high risk pregnancies. A careful history and physical examination of every obstetric patient also helps in identifying high risk pregnancies. Regular prenatal check ups also help in identifying risk at an early stage. 

HOW TO PREVENT HIGH-RISK PREGNANCY?     

Staying healthy is probably the first step that one needs to do to lower the risk of having a difficult pregnancy. Consider pre conception evaluation by a health care provider to ensure fitness for a pregnancy.  

Even during the pregnancy, there are steps that can be taken to reduce the risk of certain problems: 

• Taking at least 400 micrograms of folic acid (a type of vitamin B) every day before and during pregnancy. 
• Getting proper immunizations. 
• Maintaining a healthy weight; eating a good diet; getting regular physical exercise. 
• Smoking, alcohol, or drug use should be strictly avoided. 
• Prenatal care appointments early during pregnancy and visiting a health provider for regularly scheduled appointments throughout the pregnancy should be given prime importance.  

WHEN TO SEEK IMMEDIATE MEDICAL CARE IN HIGH-RISK PREGNANCY?  

• Vaginal bleeding  
• Watery discharge from the vagina  
• Painful urination   
• Vomiting or consistent nausea  
• Blurred vision   
• Pain in the lower abdomen area  
• Fever or chills  
• Self-harm thoughts  
• Sudden swelling in the face and hands  

HOW TO MANAGE HIGH-RISK PREGNANCY?  

Quality prenatal care with multidisciplinary team approach helps in managing high-risk pregnancies 

The main objective of prenatal care is prevention and treatment of abnormal outcomes in both the mother and the baby. Quality prenatal care includes accurate estimation of dates, detailed history of the mother and certain  investigations to rule out any high risk factors, screening tests to rule out chromosomal abnormalities, obstetric scans by fetal medicine specialists, regular antenatal visits with obstetrician, necessary investigations to identify high risk conditions, multidisciplinary approach for managing  high risk pregnancies , perinatal  counselling for high risk fetal conditions, fetal surveillance by  NST, regular growth scans and doppler studies and finally formulating a line of management for improving maternal and foetal outcomes. 

High-risk pregnancy treatment varies from case to case. The type of treatment offered depends upon the type of disease, its effect on the baby, the patient’s overall health condition and more. Most of the high-risk pregnancy complications can be treated effectively if the condition is highlighted in the early stages. This is why it is more important to have regular prenatal care. Management may sometimes need involving specialists from various branches. The multidisciplinary team approach has emerged as a way of providing comprehensive medical care by bringing together professionals from a wide range of disciplines in a coordinated and effective manner to improve maternal and neonatal outcome. High risk pregnancies need to be managed in a tertiary care center where multi disciplinary team approach is possible. 

Dr. MVR Shailaja – MS(OBG), DGO, Consultant Obstetrician and Gynecologist

Dr. MVR Shailaja

Consultant Obstetrician and Gynecologist

Rainbow Children’s Hospital and BirthRight Clinic, Visakhapatnam