The term high-risk pregnancy refers to any pregnancy that may pose a risk—increase health problems, complications, or death— to the mother or her fetus either during pregnancy – or during or following childbirth.
RISK FACTORS FOR HIGH-RISK PREGNANCY
Specific factors that might contribute to a high-risk pregnancy include:
- A history of miscarriage or the death of a newborn shortly after birth
- A premature birth or post-term pregnancy, that is, the birth of a baby before 37 weeks of pregnancy or a prolonged pregnancy that has extended to or beyond 42 weeks of gestation
- A history of two miscarriages or more
- A history of giving birth to newborns with a weight of less than 2,500 grams or more than 4,000 grams at birth
- A history of slow fetal growth
- A history of giving birth to a child with an intellectual disability (ID, or mental retardation-MR)
- A history of preeclampsia
- Previous hysterectomy or other obstetric and gynecologic surgery
- Multifetal (multiple) pregnancy
- Fetal malpresentation, such as breech or transverse presentations (from 34 weeks onward)
- Maternal age of less than 16 years or more than 40 years
- Vaginal bleeding or spotting during pregnancy
- Rh-negative blood type
- Development of a pelvic mass during pregnancy
- Maternal hypertension, which is defined as having a blood pressure of greater than or equal to 140/90 mm Hg
- Having insulin-dependent diabetes
- Kidney disease
- Heart disease
- Drug or alcohol abuse
- Internal medical conditions and diseases, such as anemia, hyperthyroidism, systemic lupus erythematosus (SLE), thalassemia, epilepsy, and tuberculosis, etc.
- If the patient has HIV/AIDS, any sexually transmitted diseases (STDs), or is a hepatitis B virus carrier
Pregnant women or women planning on becoming pregnant who have any of the above risk factors should seek medical advice and care from a well-equipped hospital that has both the proper equipment and medical personnel with the necessary experience and expertise to ensure treatment and care that is appropriate, precise, and safe.
HIGH-RISK PREGNANCY DIAGNOSIS
When an expectant mother begins prenatal care at the hospital, healthcare providers will perform an assessment to determine whether or not she is likely to experience a high-risk pregnancy. Doctors will do this by examining her medical history for possible risk factors, using routine prenatal screening tests along with additional tests or procedures, such as:
- Urinalysis for sugar and protein level screening. Detection of excess protein in the urine coupled with high blood pressure can be an indication of preeclampsia, while high sugar levels in the urine can be a marker for gestational diabetes. Doctors will also do further blood sugar level testing to confirm whether or not diabetes is in fact present.
- Assessment of weight and height
- High blood pressure test
- Fundal height measurement to estimate the size of the fetus/baby
- Other tests and assessments per the doctor’s recommendations
FETAL ASSESSMENT DURING PREGNANCY
Expectant mothers who have been diagnosed with a high-risk pregnancy should receive close monitoring and prenatal care throughout their pregnancy, and should meet with their doctor more frequently than pregnant mothers without risk. Mothers with high-risk pregnancies may undergo additional testing for any fetal abnormalities in order to help with planning and further treatment. Examples of fetal monitoring and assessment include:
- Fetal ultrasound – A test that uses high frequency sound waves to check for problems and gather information about the pregnancy, any fetal or placental abnormalities, as well as the morphology and physiology of the fetus, uterus, placenta, umbilical cord, and amniotic fluid without causing any harm to the mother or the fetus.
- Prenatal screening for Down’s syndrome can be done in a variety of ways, such as
- The First Trimester Combined Test – This can be carried out between 11-13 weeks of pregnancy using a special ultrasound scan known as a nuchal translucency (NT) test along with a blood test. This combined test detects 85% of cases of Down’s syndrome with a 5% false-positive rate.
- Second Trimester Prenatal Quadruple Test – In cases where the mother begins prenatal care after the first trimester, a blood test can be carried out between 15 and 20 weeks of pregnancy. It detects up to 85% of cases with a false-positive ratio of 5%.
- NIFTY Test (Non-Invasive Fetal Trisomy Test) – This uses the latest genetic sequencing technology in screening for Down’s syndrome by analyzing the cell-free fetal DNA in the maternal bloodstream. This method has an over 99% accuracy rate in detection of trisomy conditions such as Down’s syndrome – with a false-positive rate of less than 1%. This test can be carried out any time after 12 weeks of gestation, with results available within 2-3 weeks after the blood test.
- Amniocentesis – Carried out between 18-20 weeks of pregnancy. Amniocentesis involves the analysis of fetal cells for prenatal diagnosis of a variety of disorders, such as chromosomal abnormalities, thalassemia, or other genetic disorders.
- Other prenatal tests and screenings per your doctor’s recommendations, such as chorionic villus sampling (CVS), cordocentesis (also known as percutaneous umbilical blood sampling or PUBS), or the non-stress test (NST), etc.
PREVENTION AND TREATMENT OF HIGH-RISK PREGNANCY
Prenatal self-care of expectant mothers facing high-risk pregnancy is incredibly important, for the safety and wellbeing both of the baby and of the mother herself. Careful, health-focused attention will go a long way in ensuring the happiness of the pregnant mother and will help the baby be healthy and strong. Of course, prenatal self-care may vary on an individual basis, depending on the condition of the mother and unborn child. A doctor should be consulted to identify the correct approach. It’s important that expectant mothers practice the following:
- Prepare for pregnancy with pre-pregnancy health check-ups for both the mother and father. If any health conditions are detected, take the required steps to treat or control the issues before becoming pregnant. For example, patients with high blood pressure should take the necessary steps to control blood pressure within a normal range before becoming pregnant. Patients who are overweight should try to lose weight through a healthy diet and exercise before becoming pregnant.
- Those planning on getting pregnant should begin taking folic acid 2-3 months prior to conception in order to prevent birth defects such as spina bifida or other neural tube defects.
- As soon as someone has discovered that they are pregnant, antenatal care should include notifying their healthcare provider of their medical history and any pre-existing medical conditions so that they can properly plan for care and treatment throughout the pregnancy. Pregnant mothers should always take time for regular scheduled appointments with their doctor.
- Avoid smoking, consuming alcohol, or taking any recreational drugs.
- Try to avoid travel or any other activities that may have any negative effect on the fetus.
- Have urine tests, and have weight and blood pressure checked during every doctor’s visit in order to monitor for abnormalities or complications that may occur during pregnancy.
- Maintain a healthy bodyweight; avoid being either underweight or overweight during pregnancy.
- Women who have high blood sugar should control their sugar levels with a healthy diet and regular exercise. Consult a physician on exercises that will not have negative effects on the pregnancy, and regularly monitor blood sugar levels.
- Reduce stress and anxiety.
- Get enough rest.
SYMPTOMS REQUIRING MEDICAL ATTENTION
Expectant mothers should see a doctor to check for any abnormalities and undergo treatment if they notice any of the following symptoms:
- Frequent headaches
- Abdominal pain or cramping
- Larger or smaller than normal stomach size
- Vaginal bleeding
- Decreased or non-existent fetal activity after 5-6 months of pregnancy
HEALTHCARE PROFESSIONALS INVOLVED IN HIGH-RISK PREGNANCY CARE
- Obstetrician/gynecologists (OB/GYN) with experience and expertise in pregnancy and high-risk pregnancy, as well as neonatologists (subspecialty of pediatrics consisting of medical care for newborn infants, especially those born with abnormalities or birth defects) will be the primary healthcare providers and advisors of mothers with high-risk pregnancies. This includes the care of the mother and child from conception to birth.
- Throughout labor and delivery, mothers will be closely monitored by their healthcare team, comprised of an obstetrician/gynecologist, anesthesiologist, delivery room nurses and neonatal intensive care unit (NICU) nurses, all of whom have expertise and training in neonatal critical care and are available to provide excellent service 24 hours a day.