fetal complications, high-risk pregnancy, maternal morbidity
G Dangal. High-risk Pregnancy. The Internet Journal of Gynecology and Obstetrics. 2006 Volume 7 Number 1.
Pregnancy is usually a serene time of unparalleled joy and expectation in a women's life. However, sometimes it can be complicated by illnesses or medical conditions. Some five to ten percent of pregnancies are termed “high risk.” Certain conditions or characteristics, called risk factors, make a pregnancy high risk. Identifying high-risk pregnancies ensures that women who most need medical care receive it in a specialized center.
A high-risk pregnancy diagnosis shouldn't automatically have a negative connotation. With proper care, 90 to 95 percent of high-risk pregnancies produce healthy and viable babies. The earlier a problem is detected, the better the chances that both mother and neonate will stay healthy. With the development of medical technology, pregnant women can be carefully monitored for signs and symptoms of high-risk pregnancies and manages well skillfully.
There is no formal or universally accepted definition of a “high-risk” pregnancy. A pregnancy is considered high-risk when maternal or fetal complications are present that could affect the health or safety of either the mother or baby. All pregnancies should be evaluated to know whether there are or will be risk factors. Risk factors present before pregnancy, problems in a previous pregnancy, disorders present before pregnancy and risk factors that develop during pregnancy can make a pregnancy high risk. Identifying a pregnancy as high risk helps ensure that it receives extra attention and proper care, thereby significantly decreasing maternal and neonatal morbidity and mortality rates1.
Risk Factors Present Before Pregnancy
Some physical and social characteristics of women, problems that have occurred in previous pregnancies and certain disorders in women may complicate pregnancy.
Women weighing less than 100 pounds (< 45 kg) before becoming pregnant are more likely to deliver low-birth-weight babies. Obese women are more likely to have macrosomic babies. Also,
Problems in a Previous Pregnancy
When women have had a problem in one pregnancy, they are more likely to have a problem, often the same one, in subsequent pregnancies. Such problems include having had a premature baby, an underweight baby, baby with birth defects, a previous miscarriage, a post-term delivery (after 42 weeks), or a delivery that required a cesarean section 1,4,5,6.
Disorders Present Before Pregnancy,
After they become pregnant, they may need special care, often from an interdisciplinary team.
Pregnancy may worsen heart disease or cause heart disease to produce symptoms for the first time. Pregnant women with heart disease may become unusually tired and may need to limit their activities. Rarely, women with severe heart disease are advised to have an abortion early in pregnancy. Risk is also increased during labor and delivery. Primary pulmonary hypertension and Eisenmenger's syndrome are examples of heart disease where pregnancy is inadvisable.
The fetus may be born prematurely. Women with birth defects of the heart are more likely to have children with similar birth defects. Ultrasonography can detect some of these defects before the fetus is born.
Newborns of women with diabetes are at increased risk of having hypoglycemia, low calcium, and high bilirubin levels in the blood.
Risk Factors/Disorders That Develop During Pregnancy
During pregnancy, a problem may occur or a condition may develop to make the pregnancy high risk. For example, pregnant women may be exposed to something that can produce birth defects (teratogens), such as radiation, certain chemicals, drugs, or infections. Infections that are teratogenic include rubella, varicella, syphilis, toxoplasmosis, and infections caused by cytomegalovirus 6, 7, 8.
They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. However; most pregnancy complications can be effectively treated.
A variation of severe preeclampsia, called the HELLP syndrome, occurs in some women. It consists of the following:
elevated levels of liver enzymes, indicating liver damage
low platelet count, increasing the risk of bleeding during and after labor.
In 1 of 200 women who have preeclampsia, blood pressure becomes high enough to cause seizures; this condition is called eclampsia. Preeclampsia may lead to placental abruption. Babies may be small because the placenta malfunctions or because they are born prematurely.
If preeclampsia worsens, women are usually hospitalized. Antihypertensives may be needed. If preeclampsia develops near the due date, labor is usually induced and the baby is delivered. If preeclampsia is severe, the baby may be delivered by cesarean section, unless the cervix is already dilated enough for a prompt vaginal delivery. After delivery, women who have had preeclampsia or eclampsia are closely monitored for 2 to 4 days because they are at increased risk of seizures. Their blood pressure may remain high for 6 to 8 weeks.
It can cause painless bleeding that suddenly begins late in pregnancy. Bleeding may become profuse, endangering the life of the woman and the fetus. Ultrasonography helps in identifying placenta previa and distinguishing it from a placental abruption. Women who bleed profusely may need repeated blood transfusions. When bleeding is slight and delivery is not imminent, patient is advised to take bed rest in the hospital. A cesarean section is almost always performed before labor begins.
The usual treatment is bed rest. If symptoms lessen, women are encouraged to walk and may be discharged from the hospital. If bleeding continues or worsens or if the pregnancy is near term, an early delivery is often best for the woman and the baby. If vaginal delivery is not possible, a cesarean section is performed.
Specialized care should be given to women who are experiencing complications or problems during their pregnancies including: preterm labor; pregnancy-induced hypertension; bleeding; chronic hypertension; diabetes; asthma or hyperemesis, etc.
Treatment for problems in pregnancy ranges from weekly or monthly ultrasound monitoring to complex intravenous infusions and medication management in hospitals— all delivered with the utmost care.
Women with chronic medical conditions, such as lupus, cancer, diabetes, or arthritis, are all at risk for complicated pregnancies. Also, a family history of mental retardation or birth defects can indicate a high-risk pregnancy. Likewise, women who have experienced miscarriages, pre-term deliveries, stillbirths, or neonatal deaths need specialized care to ensure a healthy pregnancy and birth. Cigarette smoking, alcohol abuse, and drug abuse put mother and child at risk, but are factors which can be controlled.