High Risk Obstetrics

What is a High-risk Pregnancy?

A high-risk pregnancy is a pregnancy that poses a threat to a woman before or during pregnancy, or after delivery. A high-risk pregnancy demands regular monitoring and special care of both you and your baby throughout your pregnancy. Recognising the cause of a high-risk pregnancy and taking care of you and your baby is considered the best strategy to prevent complications.

Causes of a High-risk Pregnancy

A high-risk pregnancy may occur due to a pre-existing medical condition or problems that can develop during the course of pregnancy. Factors that can cause high-risk pregnancies may include:

  • Lifestyle: Alcohol consumption, smoking and use of illegal drugs
  • Maternal age: Pregnancy at 35 years or above
  • Underlying condition: Diabetes, high blood pressure, anaemia (low oxygen carrying haemoglobin levels in blood), epilepsy (neurological disorder), to name a few
  • Medical history: Genetic conditions, prior pregnancy loss (death of baby), history of C-section or preterm birth (early birth of your baby i.e., before 37 weeks of gestational period)
  • Pregnancy complications: Problems in your uterus, placenta or cervix, too much or too little amniotic fluid (fluid surrounding and protecting the baby in the womb), suppressed foetal growth, when your baby’s blood group is Rh positive and yours is Rh negative, and severe morning sickness.

Diagnosis of a High-risk Pregnancy

Your doctor may recommend various diagnostic tests to diagnose a high-risk pregnancy:

  • Amniocentesis : A sample of the amniotic fluid is collected after 15 weeks of pregnancy to examine genetic conditions such as neural tube defects (brain and spinal cord abnormalities).
  • Ultrasound scan: An ultrasound produces images of the foetus to check for abnormal development.
  • Chorionic villus sampling: A sample of cells removed from the placenta between weeks 10 and 12 of pregnancy is examined for genetic abnormalities.
  • Lab tests: Vaginal secretion is analysed for the presence of foetal fibronectin (glue-like substance between the lining of the uterus and foetal sac), which can indicate preterm labour.
  • Cordocentesis: Foetal blood sample is collected from the umbilical cord after week 18 of pregnancy to detect chromosomal variations, infections and any blood disorders.
  • Biophysical profile: Foetal heart rate and foetal ultrasound are performed to examine your baby’s well-being.
  • Cervical length measurement: An ultrasound technique that measures the length of your cervix can identify preterm labour.

Steps to Promote a Healthy Pregnancy

The following are some steps that can prevent risks during pregnancy:

  • Preconception appointments: It is good to consult your doctor before planning to get pregnant. You can discuss your medical condition and understand your overall health and chances of pregnancy in detail during your consultation.
  • Regular prenatal care: A regular prenatal visit can help your doctor monitor yours and your baby’s health.
  • Healthy diet: You will be advised to follow a healthy diet and take essential nutrients like folic acid, calcium and iron.
  • Avoid risky substances: You are advised to quit smoking, alcohol and illegal drugs to prevent complications during pregnancy.
  • Weight gain: A weight gain of approximately 25 to 35 pounds is recommended if you have had a healthy weight before pregnancy.

Managing a High-risk Pregnancy

Things you need to know about high-risk pregnancies:

  • A home birth is not recommended for women having high-risk pregnancy. It is generally considered safe to deliver your baby in a health care unit or hospital.
  • You are advised to report to your doctor if you have vaginal bleeding, pain or cramps in the lower abdomen, watery vaginal discharge or decreased foetal movements.

High-risk pregnancies may instil fear in many, but it is important to stay positive and follow your doctor’s instructions for a healthy and successful pregnancy.

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