High Risk Pregnancy – How to manage it

Any pregnancy that poses a risk to the mother or baby, or is different from normal is considered as high-risk pregnancy.

What are the risk factors for high-risk pregnancies?

Sometimes a high-risk pregnancy is the result of a medical condition or disease present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk pregnancy.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age.Pregnancy risks are higher for mothers older than age 35 years.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using certain drugs can put a pregnancy at risk.
  • Medical history. A history of hypertension, diabetes, heart disorders, breathing problems such as poorly controlled asthma, infections, and blood-clotting disorders such as deep vein thrombosis can increase pregnancy risks.
  • Surgical history. A history of surgery on your uterus, including  C-sections, multiple abdominal surgeries or surgery for uterine tumors (fibroids), can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy can pose risks. Examples include an abnormal placenta position, bleeding during pregnancy, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh-positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher-order multiple fetuses.

What steps can you take to promote a healthy pregnancy?

Whether you know ahead of time that you’ll have a high-risk pregnancy or you simply want to do whatever you can to prevent a high-risk pregnancy, follow the instructions by your Gynecologist. For example:

  • Schedule a preconception appointment.If you’re thinking about becoming pregnant, consult your Gynecologist. She might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your health care provider might also discuss your risk of having a baby with a genetic condition.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Eat a healthy diet. During pregnancy, you’ll need more folic acid, protein, calcium and iron. A daily prenatal vitamin can help fill any gaps. Talk to your Gynecologist if you have special nutrition needs due to a health condition, such as diabetes.
  • Gain weight wisely. Gaining the right amount of weight can support your baby’s health — and make it easier to shed the extra pounds after delivery. Work with your Gynecologist to determine what’s right for you.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. Get your health care provider’s OK before you start — or stop — taking any medications or supplements.

Do you need special tests?

If you have a high-risk pregnancy, you might consider various tests or procedures in addition to routine prenatal screening tests. Depending on the circumstances, your Gynecologist might recommend:

  • Specialized or targeted ultrasound.This type of fetal ultrasound, an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus  targets a suspected problem, such as abnormal development.
  • During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 14 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
  • Chorionic villus sampling (CVS).During this procedure, a sample of cells is removed from the placenta. Usually done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby’s blood is removed from the umbilical cord for testing. The test can identify certain genetic disorders,  conditions and infections.
  • Ultrasound for cervical length. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you are at risk of preterm labor.
  • Laboratory tests. Your health care provider will test your urine for urinary tract infections and screen you for infectious diseases such as HIV and syphilis.
  • Biophysical profile. 2This prenatal test is used to check on a baby’s well-being. It might involve only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. The decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your Gynecologist.

Dr. Ruchi Tandon is a gynecologist specialising in high risk pregnancy, with over 14 years of clinical experience. She is currently associated with leading hospitals of South Delhi such as Max Smart Superspeciality Hospital, saket, Apollo Cradle Royale, Nehru Place and Apollo Spectra, Kailash Colony.

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