A pregnancy is considered 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 help ensure the best outcome for the mother and baby.
Risk Factors for High-Risk Pregnancy
Maternal Age: One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications. The risk of miscarriage and genetic defects further increases after age 40.
Medical conditions that exist before pregnancy: Conditions that can pose risks to the mother or baby include:
- High blood pressure
- Lung, kidney, liver or heart problems
- Diabetes
- Depression
- Obesity
- Autoimmune disease
- Sexually transmitted diseases (STDs)
- Long-term (chronic) infections such as human immunodeficiency virus (HIV)
A history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are also risk factors for a high-risk pregnancy.
Medical conditions that occur during pregnancy: Even if you are healthy when you become pregnant, it is possible to develop or be diagnosed with problems during pregnancy that can affect you and your baby. Three of the more common pregnancy-related problems are:
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Hypertensive Disorders of Pregnancy
This includes gestational hypertension which may progress to preeclampsia and eclampsia.
Preeclampsia is a syndrome that includes high blood pressure, loss of protein in urine, and generalised swelling. The risk of this complication increases if you are known hypertensive, obese, of advanced age, diabetic, carrying multiple pregnancy, history of previous pregnancy with preeclampsia or any chronic illness.
Eclampsia is when preeclampsia is associated with convulsions.
All these disorders can cause various fetal complications including fetal growth restriction, oligohydramnios, preterm deliveries and intrauterine fetal death.
- Placenta Previa – Placenta’s primary function is to provide the baby with oxygen and nutrients to grow properly. Placenta is implanted in the uterus, commonly, in the fundus anteriorly or posteriorly. But in case of Placenta Praevia, it covers the mouth of the uterus. This increases the chances of bleeding during pregnancy and normal delivery is not possible in complete placenta previa. Thus the pregnancy is at high risk due to various complications like anemia due to blood loss, premature delivery, delivery by caesarean, excessive bleeding during delivery and post-delivery.
- Gestational diabetes Diabetes which develops during the course of pregnancy is called gestational diabetes. Risk factors for developing gestational diabetes is Asian race, obese, women with polycystic ovarian syndrome, advanced age, multiple pregnancies. WHO has recommended that every woman should be screened for diabetes during pregnancy with or without risk factor. It can give rise to complications like macrosomic baby, polyhydramnios and increase risk of caesarean section.
- Depression. Between 14% and 23% of women get depressed during pregnancy. It’s more likely if you've been depressed before. Pregnancy may be linked to depression because of hormonal changes, exhaustion, stress at home, and a lack of support. In turn, depression may be linked with problems during pregnancy and delivery, low birth weight, and preterm birth. Go over the risks and benefits of taking medicine while pregnant or breastfeeding.
Monitoring the Fetus in a High-Risk Pregnancy
A biophysical profile (BPP) may be scheduled for women whose pregnancies are considered high-risk. This is a test that checks fetal health. It combines a nonstress test (NST) with an ultrasound exam, and it's usually done after the 28th week of pregnancy.
An NST is usually done to evaluate the health of the fetus. It involves placement of a fetal monitor on the mother's abdomen and interpretation of the fetal heart rate in response to fetal movements. It generally takes 20 to 30 minutes.
The BPP is an ultrasound exam which looks for
- Fetal tone
- Fetal breathing
- Fetal movements
- Amniotic fluid volume
It is recommended to do frequent BPP in the following condition:
- Overdue pregnancy
- A condition like high blood pressure, diabetes, and heart or kidney disease
- Multiple gestation (twins, triplets)
- Decreased amniotic fluid (oligohydramnios)
- Small baby (intrauterine growth restriction)
- Placental abnormality
- Previous unexplained fetal death
- Maternal perception of decreased fetal movement
- Premature rupture of fetal membranes
- Concern for fetal well-being