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What is a High-Risk Pregnancy?
Any pregnancy where either the pregnant woman, her fetus, or both, are at potential risk of having health problems or adverse outcomes, as compared to uncomplicated pregnancies, is labelled ‘High-Risk Pregnancies’. These women may need specialized care or treatment to have healthy outcomes. The specific type of care needed will depend on the specific risk factors, as well as the general overall health of the mother and the fetus.
Primarily the pregnancy may be at risk because of maternal, fetal or placental causes.
For High-Risk Pregnancy Treatment in Bangalore visit Manipal Hospital near you. They have the best gynecology doctor in Bangalore especially trained to treat and take care of high-risk pregnancies.
Maternal Factors
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Pre-existing Medical disorders
Pre-existing Medical disorders such as Hypertension, Diabetes Mellitus, Kidney diseases, autoimmune conditions, epilepsy, obesity, sexually transmitted illnesses, bleeding diathesis, fibroids, cancers, thrombotic disorders, infections like zika, coronavirus etc.
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Age
Teenage or women more than 35 years old are at a higher risk of developing High blood pressure, pre-eclampsia, gestational diabetes, and genetically abnormal pregnancies. An increase in artificial reproductive techniques like IVF, ICSI etc., leads to an increase in multiple pregnancies, which puts both mother and fetus at risk.
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Conditions of pregnancy
Multiple pregnancies, hypertensive disorders, gestational diabetes, adherent placenta, and prematurity.
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Past History
Poor previous pregnancy outcomes, recurrent pregnancy losses, intrauterine fetal demise, preterm delivery, hypertensive disorders, excessive blood loss at delivery, previous caesarean delivery, and thrombotic disorders.
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Previous surgical history
Certain surgeries have a bearing on the outcome of subsequent surgeries: myomectomy (removal of fibroids), surgical treatment for cancers, multiple cesarean deliveries, and bariatric surgery.
Previous Medical History
Improvements in healthcare facilities are leading to the identification of cures or better control of more diseases and subsequently, women can go through pregnancy despite these conditions with better outcomes than before. For example -Post-transplant pregnancies- renal, liver or uterine, women with cardiac and renal diseases, SLE, autoimmune disorders etc., who were earlier forbidden to get pregnant are now able to do so and carry it successfully to viability.
Medications
Women may be on medications for other diseases like epilepsy, Hepatitis B, HIV, SLE etc. and may require closer monitoring for the impact of disease and medication on pregnancy physiology and fetus and the impact of pregnancy on the disease and fetus.
Disease during pregnancy, Unfortunately, some women are diagnosed with cancers during pregnancy. The treatment poses a challenge requiring inputs from a multidisciplinary team comprising Obstetricians, medical & surgical oncologists, radiologists, anesthesiologists, Neonatologist etc
Lifestyle factors
Alcohol, smoking, use of recreational substances
Fetal Factors
Neonatology has undergone a revolution in the last two decades and any problems detected early and evaluated well have a much more favourable outcome.
Prematurity
Twenty - five years ago, saving a baby born at thirty - six weeks was big news! With advances in neonatology, we are now routinely able to save babies born at twenty-six weeks comfortably and are looking forward to saving even those at 24 weeks!
Fetal growth problems
Both restriction in growth, and overgrowth- macrosomia. These conditions require close monitoring and timely delivery to prevent an adverse outcome
Fetal Structural abnormalities
Fetal Medicine has advanced by leaps and bounds and we can now diagnose babies with structural malformations well before they are born. The ability to recognize these problems early helps in multidisciplinary interactions to evolve an effective birthing plan resulting in a healthy mother and child. Examples include tracheoesophageal fistula, congenital diaphragmatic hernia, and certain cardiac diseases. Such babies if undiagnosed, or not anticipated, would have surely succumbed.
Fetal functional problems
Anemia may result due to Rh isoimmunization, or complications due to multiple gestations, and may need intrauterine blood transfusions and immediate intervention at delivery in terms of airway
Certain cardiac arrhythmias in the babies can be managed with medications administered to the mother
Fetal Interventions
Chorion Villus Biopsy and amniocentesis for the diagnosis of genetic disorders, Fetal Reductions, LASER cord coagulation for some cases of monochorionic twins, amnioreduction in cases of TOF, CDH, amnioinfusion are all possible if required
Placental factors
The placenta is the conduit between the mother and the fetus. It is formed when the embryo implants into the uterus and establishes vascular connections that enable the transportation of oxygen and nutrients from the mother to the fetus and return waste products to the maternal circulation. Abnormalities can be with respect to:
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Site of implantation - Placenta praevia
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Depth of implantation - accreta, increta and percreta.
These mothers will require transfusion of adequate blood and blood products at delivery, need for an ICU if required, and a possible hysterectomy (removal of the uterus)
Functional abnormalities
Fetal growth restriction, Less fluid (Oligoamnios) or more fluid (Polyhydramnios) around the baby, Pre-eclampsia
Complications at Labour
These may be anticipated and unanticipated problems.
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Haemorrhage before or after delivery may be anticipated in patients with preeclampsia, previous history, presence of fibroids, large babies, polyhydramnios etc.
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Convulsions may be anticipated in epileptics and poorly controlled high blood pressures in pregnancy
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Cord or hand prolapse in cases of transverse lie where the baby lies horizontally instead of vertically
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Shoulder dystocia in cases of big-size babies, gestational diabetes
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Conditions like amniotic fluid embolism are fortunately rare!
In short, pregnancy is a long journey and can become complicated at any stage: from the stage of becoming pregnant (infertility) through the three trimesters to even after delivery! Although the pregnancy is labelled as ’high risk’, it doesn’t mean that a healthy outcome is not possible. It is important to identify and treat these women with previous pregnancies at a centre with an excellent High-Risk Pregnancy Unit that will provide holistic care.
This unit will comprise of:
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Experienced Obstetricians
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Excellent Fetal Medicine Unit
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Neonatologist, with a well-equipped NICU
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Anaesthesiologists,
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Operation Theater complex
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24x7 blood and blood product availability
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Round the clock Intensivist with a well-equipped ICU
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Units managing the medical disorders of the adult - endocrinologist, rheumatologist, nephrologist, urologist, neurologist
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Units managing medical and surgical problems of the child- Paediatric Surgeon, cardiologist, nephrologist
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Interventional Radiologist
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Geneticist
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Clinical Psychologist,
We, at Manipal Hospital, have been providing care to all women with high-risk pregnancies ever since its inception. Our greatest strengths are our dedicated team of doctors, nurses and support staff ranging across multiple specialities and subspecialties, excellent feto-maternal sonologists, globally reputed neonatologists & NICU, a well-equipped and dedicated multidisciplinary ICU, state-of-art OT manned by anaesthesiologists round the clock, efficient laboratory services, not to forget our well-stocked excellent blood bank!
We are happy to launch this High-Risk Pregnancy (HRP) Clinic -for an appointment, contact Ms Sumitra Ph No:+91 9886397310, who will briefly understand the problem and organize a meeting with the doctors from the relevant multiple specialities to ease your problems
We are also very happy to launch this HRP web corner- which will provide you with some insight into the various high-risk pregnancy conditions every week! If there is any particular condition you would like us to address, please do so in the chatbox and we will address it in the following week!
We begin the next week with ‘Prematurity’.
Manipal Hospital is the Best Gynaecology Hospital in Old Airport Road, Bangalore having trained gynecologist in Bangalore who has experience diagnosing and treating a wide range of conditions, from common to complex.
