What is a High Risk Pregnancy?

What is a high-risk pregnancy?

 A high-risk pregnancy is the one in which the chances of having complications are more. Needs more strict antenatal monitoring and regular and frequent checkups.

Which all conditions are called high-risk pregnancy? 

Elderly Primigravida (1 st pregnancy at the age>/=35 yrs; diabetes mellitus, hypertension, placenta previa, jaundice in pregnancy, previous preterm deliveries (bad obstetrics history), severe anemia, thrombocytopenia, heart disease, kidney disorder, previous 2 or 3 caesareans, IVF conception, HIV positive pregnancy, Hepatitis B positive pregnancy, previous malignancy, fibroid uterus, uterine anomalies, fetal anomalies, age on delivery less than 16 years, obese, twin or multiple pregnancies, Rh Negative pregnancy.

Reasons for a high risk are smoking, unhealthy lifestyle, obesity, fibroid uterus, delayed detection of medical complications in pregnancy (better go for pre conceptional counseling).

Why we have more high-risk pregnancies now?

Because of the increasing rate of late marriages, late age of conception, infertility treatments, and IVF conceptions. Increase in pre-pregnancy risk factors such as obesity, hypertension, thyroid disorders, and diabetes mellitus. Pregnancy complications like gestational diabetes mellitus, pre-eclampsia, increase cases of birth defects, placenta previa have increased.

How to prevent complications in high-risk pregnancy? 

Good ANC care from a qualified doctor and planning delivery in a specialized center is the key to a successful outcome. Detecting changes of complications early might help us to delay the complications to a stage where if delivery required our baby is out of danger. Better start with a pre-conceptional check-up and start treatment even before conception. The most important thing is that a healthy pregnancy can grow in a healthy body. So first have a healthy and fit body before conceiving. Make sure you have taken your pre-natal vitamins, eating a healthy diet and exercising regularly. A Center with an adequate nursery care facility is needed for the same. Preterm delivery chances are high in such patients.

What complication can we expect during labour? 

A high-risk pregnancy can be anticipated with labour complications. Prolonged labour, shoulder dystocia, retained placenta, uterine inversion, rupture uterus, perineal tear, intrauterine growth restriction, preterm labour are very common complications in high-risk deliveries. High-risk pregnancies have more chances of caesarean section; though the trial of labour can be given depending on the risk to mother and fetus.

Effect of high-risk pregnancy on the baby is low birth weight baby, preterm baby, premie babies, intrauterine death, prolonged nursery stay and asphyxia & malformations in the baby.

The complication can occur in all three trimesters. Third-trimester complications can be fatal. Placenta Praevia, Placenta Accreta, PPH, uterine rupture, inversion, and hypertensive crisis.

Any low-risk pregnancy can become high risk at the time of delivery. And it is not necessary that all high risk will have complications in the third trimester and delivery.

High-risk pregnancies dealt with successfully at Manipal hospital. 

Various cases of placenta previa, eclampsia, severe anemia, heart disease have had a successful outcome here. High-risk cases besides the common ones have been three patients of nephrotic syndrome who had Intrauterine growth restriction and Pre-Eclampsia in the third trimester but as per good ANC care and anticipated issues, the cases went home well. A case of EPHVO was dealt with with severe PPH and saved in time. Few cases of multiple fibroids and fibroids in the lower segment were dealt well. A handful of patients had kidney stones and few detected with chronic kidney disease during pregnancy were dealt with very well, stenting was done in few of them. An emergency gall bladder removal was also done for a patient in the second trimester as her pain was not subsiding g.

Successful delivery is forgotten like the morning sun but a complicated case is not forgotten throughout life.

A high-risk pregnancy is a challenge to the obstetrician and the neonatologist. But every successful outcome makes way for new cases to be dealt with much more confidence and surety. For the parents is a roller coaster journey but when they see their children growing up smoothly all the pain is forgotten. So keep smiling and do your best.

 

Dr. Yaschia Gudesar

HOD And Consultant - Obstetrics & Gynaecology

Manipal Hospital, Dwarka, Delhi

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