High Risk Pregnancy: What To Expect?

Causes of High-Risk Pregnancy

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

Pre-existing Medical disorders

Pre-existing Medical disorders include Hypertension, Diabetes Mellitus, Kidney diseases, autoimmune conditions, epilepsy, obesity, sexually transmitted illnesses, bleeding diathesis, fibroids, cancers, thrombotic disorders, infections like zika, coronavirus etc.

Age Factors

Teenagers or women more than 35 years old generally fall into the high risk pregnancy age group. These individuals are often 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.

Lifestyle factors

These include the use of alcohol, smoking and recreational substances.

Conditions of pregnancy

Multiple pregnancies, hypertensive disorders, gestational diabetes, adherent placenta, recurrent pregnancy losses, intrauterine fetal demise, preterm delivery, excessive blood loss at delivery, previous caesarean delivery, thrombotic disorders, and prematurity.

Past Medical and Surgical 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 including 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. 

Moreover, certain surgeries such as myomectomy (removal of fibroids), surgical treatment for cancers, multiple cesarean deliveries, and bariatric surgery have a bearing on the outcome of subsequent surgeries.

Medications and Their Impact

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. 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, neonatologists etc.

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 and Neonatal Outcomes 

25 years ago, saving a baby born at 36 weeks was big news. With advances in neonatology, we are now routinely able to save babies born at 26 weeks comfortably and are looking forward to saving even those at 24 weeks.

Fetal Growth Problems

Both restriction in growth, and overgrowth, known as macrosomia are conditions that require close monitoring and timely delivery to prevent an adverse outcome. 

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 map 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.  

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, including airway management. Certain cardiac arrhythmias in 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 the implantation site and depth of the placenta.

These include placenta praevia, 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

These include fetal growth restriction, reduced fluid (Oligoamnios) or increased fluid (Polyhydramnios) around the baby,  and pre-eclampsia.

Types of High-Risk Pregnancy

High-risk pregnancies may occur either as a result of multiple pregnancies or due to cause-related or age-related reasons.

Based on cause:

High-risk pregnancies can be categorized based on their origin of cause:

Maternal causes

Certain underlying conditions and obstetric factors in the mother may put pregnancy at risk. These include:

• Hypertensive disorder–associated pregnancy can be caused by hypertension or chronic kidney disease.

• Diabetic pregnancy can occur as a result of the mother suffering from diabetes mellitus.

• Cardiac disease in pregnancy

• Thyroid disorders can cause thyroid disease in pregnancy

• Previous cesarean deliveries can lead to a scarred uterus

• Recurrent pregnancy losses 

Fetal causes

Sometimes high-risk pregnancies may occur due to abnormalities in the baby. These include:

• Congenital anomaly–affected pregnancy can arise as a result of structural anomalies in the fetus.

• Aneuploidy-associated pregnancy can occur due to chromosomal or genetic disorders in the fetus.

• Growth-restricted pregnancy due to fetal growth restriction 

• Multifetal pregnancy may be caused by multiple gestations (twins/triplets) 

• Infection-complicated pregnancy can occur due to fetal infections such as TORCH or Parvovirus B19.

Placental causes 

Abnormalities in placental implantation or function may result in high-risk pregnancy. Examples include:

• Placental dysfunction–related pregnancy caused by Placental insufficiency 

• Placenta previa pregnancy caused by Placenta previa

• Morbidly adherent placenta occuring as a result of Placenta accreta spectrum (accreta, increta, percreta)

• Abruptio placentae due to Placental abruption 

• Oligohydramnios / Polyhydramnios pregnancy resulting from Amniotic fluid abnormalities

Age-related Risk Types 

The age of the mother can be an important determinant of high-risk pregnancies:

• Teenage pregnancies: When the conceiving mother is less than 20 years old, it can be considered as teenage pregnancy. These are considered high-risk due to increased chances of preterm birth, obstructed labor, pre-eclampsia, maternal anemia, and nutritional deficiencies, among other issues.

• Advanced maternal age: If mothers are 35 and above, they fall into the advanced maternal age category. Risks include increased chances of chromosomal abnormalities, infertility, miscarriage and stillbirth.     

• Very Advanced maternal age: Mothers who are 45 and above generally fall into the very advanced category. Risks tend to intensify preterm birth, fetal growth restriction, and  placental issues, among others. 

Symptoms of High-Risk Pregnancy

Common Warning Signs 

A number of warning signs may be indicative of high or low-risk pregnancy, depending on the intensity of the symptoms. Common symptoms include:

• Chest pain and shortness of breath

• Abdominal pain

• Dizziness or fainting

• Nausea and vomiting

• Heart palpitations

• Self harm tendencies

When to seek medical attention

It is crucial to seek immediate help if the following symptoms persist:

• Sudden or heavy fluid leakage or bleeding from the vagina

• High fever or signs of infection

• Noticeable swelling in face, hands or feet

• Severe cramping or abdominal pain

• Slowing or stopping of fetus movement after 28 weeks

• Sudden inflammation in face, hands or feet

Management of High-Risk Pregnancy 

Careful prenatal monitoring and comprehensive strategies are key to a successful high-risk pregnancy.

Monitoring and Screening

Regular appointments with a gynaecologist are essential to monitor the vital signs of both the mother and baby. Monitoring fetal movement inside the womb is extremely important to track fetal health. A number of screening tests are also performed. These include specialized ultrasounds, genetic screenings, doppler velocimetry, and fetal echocardiogram. 

Medical and Lifestyle Management

Getting frequent medical checkups done during the pregnancy period and avoiding harmful lifestyle habits such as smoking, alcohol and illegal drug consumption improves chances of having a healthy pregnancy. 

Multidisciplinary Care Approach 

Managing a high-risk pregnancy involves coordinated support from various healthcare professionals, from maternal-fetal medicine specialists to nurses, nutritionists and genetic counsellors, among others.

Complications During Labour and Delivery 

These may be anticipated and unanticipated issues:

• Haemorrhage before or after delivery may be anticipated in patients with preeclampsia, previous history, presence of fibroids, large babies, polyhydramnios etc.

• Convulsions may be anticipated in epileptics and poorly controlled high blood pressures in pregnancy.

• Cord or hand prolapse in cases of transverse lie where the baby lies horizontally instead of vertically.

• Shoulder dystocia in cases of big-size babies, and gestational diabetes. 

• Conditions like amniotic fluid embolism are fortunately rare.

Common Labor Complications in High-Risk Pregnancies

There are 7 key labor complications that are seen in high-risk pregnancies:

• Placenta previa 

• Fetal distress

• Shoulder dystocia

• Severe bleeding 

• Rapid labor

• Uterine rupture

• Perinatal Asphyxia

High-Risk Pregnancy Care at Manipal Hospital

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. 

Multidisciplinary Team and Facilities 

This unit will comprise of:

• Experienced Obstetricians 

• Excellent Fetal Medicine Unit

• Neonatologist, with a well-equipped NICU

• Anaesthesiologists, 

• Operation Theater complex

• 24x7 blood and blood product availability

• Round the clock Intensivist with a well-equipped ICU

• Units managing the medical disorders of the adult - endocrinologist, rheumatologist, nephrologist, urologist, neurologist

• Units managing medical and surgical problems of the child- Paediatric Surgeon, cardiologist, nephrologist 

• Interventional Radiologist

• Geneticist

• Clinical Psychologist

Specialized Units and Services 

We, at Manipal Hospital, have been providing care to all women with high-risk pregnancies ever since its inception. Our greatest strengths include 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.

Conclusion 

Although high-risk pregnancies cannot be completely transformed into low-risk pregnancies, they can be effectively managed and treated with early detection, medications, regular check-ups and monitoring of symptoms. 

Importance of Early Detection and Expert Care 

Detecting pregnancy early on enables timely intervention and proactive monitoring. This allows high-risk factors to be identified and diagnosed promptly. Based on the level of risk, a personalized plan is curated to ensure that specialized care is provided to both the mother and baby. Early detection also reduces complications associated with high-risk pregnancy and improves chances of positive outcomes. 

Encouragement for Regular Checkups

Regular checkups are essential to ensure a smooth and healthy pregnancy journey. Prior to conception, regular checkups help mothers-to-be prepare for the pregnancy both physically and mentally. Close monitoring helps gynaecologists identify potential health risks and determine whether the baby is developing normally. According to the requirement, additional treatment and prenatal vitamins can be administered to ensure the safety of both mother and baby. For expert care and comprehensive support, Manipal Hospital is the Best Gynaecology Hospital in Old Airport Road, Bangalore.