High Risk Pregnancy

The term ‘High Risk Pregnancy‘may generate fear or anxiety in most parents-to-be, but it is important to remember that it does not necessarily imply that you are in some very dangerous or scary situation. High Risk Pregnancy is just a term used by the doctors to refer to any pregnancy that requires more care and monitoring during the course of pregnancy, delivery and post delivery; as compared to other, so called ‘Normal Pregnancies’. It just means that you need extra care in order to ensure that you have a healthy pregnancy and a healthy baby.

Any pregnancy can come with its own set of problems and having a high risk pregnancy means that these women have a higher chance of developing these problems. These may be just minor setbacks in the course of pregnancy but sometimes, they may cause life threatening complications also. Hence it is important to understand the implications of having a High Risk Pregnancy.

How do I know if my pregnancy is High Risk?

A pregnancy may be considered High Risk due to a number of factors that can affect the mother or the baby during or after the pregnancy. These factors may be either pre-existing or may develop during the course of the pregnancy:

Pre -existing factors include:

  • Age less than 18 or more than 35 years.
  • Women who smoke or consume alcohol have a higher risk of miscarriage, Small-for-date babies, preterm delivery, malformations in the baby and a number of other complications during & after delivery.
  • Any history of any complications in the previous pregnancy for eg- Preterm delivery, miscarriage, abruption of placenta (separation of placenta from the uterus before delivery of baby), High blood pressure / Pre eclampsia/ Eclampsia, gestational diabetes, excessive or reduced liquor during previous pregnancy, history of low birth weight or malformed baby in previous pregnancy, history of traumatic delivery or post delivery complications, history of caesarean section in previous pregnancy, ectopic pregnancy etc.
  • Pre-existing medical ailments — These include presence of any medical illnesses before the onset of pregnancy for eg- Hypertension, Diabetes, Epilepsy, Bronchial asthma, Thyroid ds, HIV, Hepatitis, Heart disease, Kidney disease, Auto-immune diseases, Blood disorders like Sickle cell anaemia or any other medical illness.
  • Prior Surgery over the uterus — For eg Myomectomy or other uterine repair surgeries, history of any surgery over the cervix.
  • Obesity, i.e a BMI of 30 or more, puts you at a higher risk of developing High blood pressure, Diabetes during the course of pregnancy. It also increases the chances of the need for an operative intervention eg. Ventouse or Caesarean section for delivery of the baby.

Factors developing during pregnancy include:

  • Low lying Placenta — or Placenta praevia, puts you at a higher risk of bleeding during pregnancy leading to preterm birth or Caesarean section. The doctor would need to monitor closely with the ultrasound scans whether the placenta has migrated upwards in the uterus during the course of the pregnancy.
  • Any bleeding or leaking — during the course of the pregnancy needs to be closely monitored & treated accordingly.
  • Short cervix.
  • Down’s syndrome or other chromosomal malformations in the baby. These would generally require extensive testing, counseling & decision regarding whether or not to continue with the pregnancy.
  • Hypertension/ Pre eclampsia — These would require very close monitoring of BP, liver & kidney function, frequent clinical examinations & blood/urine investigations along with serial ultrasound scans and antihypertensive medications to ensure the wellbeing of the mother & baby.
  • Gestational Diabetes — This again would need close monitoring of blood sugar values, liver & kidney function, Ultrasound scans etc to keep a close eye on the baby & mother’s status.
  • Twins or Multiple pregnancy.
  • Growth restriction or too large baby.
  • Decreased or Excessive liquor around the baby.
  • History of Chicken Pox, Toxoplasmosis or other infection in pregnancy.

How does it affect my Pregnancy care routine?

Having a high risk pregnancy means that you would need closer monitoring as compared to other pregnant women. Your doctor may advise you to:

  • Schedule more frequent ante-natal visits as compared to normal women. These visits are needed so that your doctor may examine you for any warning signs of a complication and also so that he/she may plan what further tests are needed to assess your baby’s and your health status. Your doctor may also need to modify your medications on these visits.
  • Have specialized tests at designated times in pregnancy to rule out chromosomal problems in the baby. These may include Double marker or Quadruple screen, Chorionic Villous sampling, Amniocentesis, Non Invasive Prenatal testing etc.
  • A High Risk pregnancy also may need to be followed up with more frequent Ultrasound scans and specialized scans at specific times for eg- Level 1 (Nuchal scan), Level 2 (Anomaly scan) or Doppler study as & when required. One should not be worried about the effects of repeated Ultrasounds on the baby as Ultrasound scans have been proven to be harmless & it is the safest way to follow the wellbeing of a high risk baby.
  • More frequent blood tests or additional blood tests may be needed to check for your Haemoglobin or Sugar levels or to assess your liver, kidney or thyroid functions. Women who have Rh Negative blood group may need regular tests to check for development of antibodies against Rh factor that may harm the baby.
  • Your doctor may ask you to keep a check on your blood pressure, regular urine examinations to check for proteinuria may also be requested.

All these tests and interventions are aimed at ensuring the wellbeing of the baby and mother and you should not get anxious or skeptical about the number of tests advised as they are done with your best interest in mind and will also help in ensuring you have a healthy pregnancy without any major complications.

What can I do to have a healthy pregnancy?

There are a lot of things that you can do to ensure that you have a healthy pregnancy and minimize complications in a High Risk Pregnancy:

  • Seek an appointment with your doctor before you plan a pregnancy in order to understand the lifestyle changes that you need to make in order to have a healthy pregnancy. Your doctor will also advise you regarding the supplements and necessary modifications in your medications that you need to make at this time.
  • Take a balanced & nutritious diet and avoid excessive weight gain before or during pregnancy. Your doctor may give you advise regarding the dietary changes that you need to make or may advise you to visit a Dietician for same.
  • Quit smoking & alcohol before you get pregnant or at least as soon as you get pregnant.
  • Exercise regularly unless you’re advised against it by your doctor. Half an hour’s exercise before & during pregnancy improves your blood circulation & overall health.
  • Be regular about the ante-natal visits & tests as advised by your doctor.
  • Do not take any medications without consulting your doctor. Similarly, do not omit any medications advised by your doctor. Be regular with your Folic acid, Iron & Calcium supplements.
  • Avoid exposure to harmful/ infectious substances or people.
  • Consult your doctor immediately if you have any alarming signs or symptoms for eg- bleeding, Leaking of fluid through vagina, severe nausea/ vomiting, high grade fever, decreased foetal movements, pain abdomen, headache or visual disturbances etc.
  • Above all, trust your doctor & have a positive attitude. It goes a long way in making healthy mothers & babies.

Originally published at www.thegynaepoint.com on August 1, 2016.