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HIGH RISK PREGNANCY


HIGH RISK PREGNANCY 

A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. High risk pregnancies are a segment of obstetrical population that produces majority of maternal and infant mortality and morbidity. High-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby.

Risk Factors for High-Risk Pregnancy

Reasons that a pregnancy may be considered high risk include:Maternal Age-One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teen and early 30s. The risk of miscarriage and genetic defects further increases after age 40.Medical conditions that exist before pregnancy- 
Conditions such as high blood pressure; lung, kidney, or heart problems; diabetes; autoimmune disorders; sexually transmitted diseases (STDS); or chronic infections such as human immunodeficiency virus (HIV) can present risks for the mother and/or her unborn baby.A history of miscarriage, problems with a previous pregnancy or pregnancies, or a family history of genetic disorders are also risk factors for a high-risk pregnancy.Medical conditions that develop during pregnancy-
Even if the mother is healthy when she becomes pregnant, it is possible to develop or be diagnosed with problems during pregnancy that can affect her and the baby. Two of the more common pregnancy-related problems are:

  • Preeclampsia is a syndrome that includes high blood pressure, urinary protein, and swelling; it can be dangerous or even fatal for the mother or baby if not treated.
  • Gestational diabetes is a type of diabetes  that develops during pregnancy. Women with gestational diabetes may have healthy pregnancies and babies if they follow the proper treatment plan. Usually the diabetes resolve after delivery. However women with gestational diabetes are at increased risk of developing type 2 diabetes. 

Pregnancy-related issues-
Often a pregnancy is classified as high risk because of issues that arise from the pregnancy itself and that have little to do with the mother's health. These include:

  • Premature labour is labor that begins before 37 weeks of pregnancy. Although there is no way to know which women will experience preterm labor or birth, there are factors that place women at higher risk, such as infections, a shortened cervix, or previous preterm birth.
  • Multiple birthsmeans mother is carrying more than one baby (twins, triplets, quadruplets, etc.). Multiple pregnancies are more common nowadays as women are using more infertility treatments. Such pregnancies increase the risk of premature labor, gestational diabetes, and pregnancy-induced hypertension. 
  • Placenta previa is a condition in which the placenta is low lying or covering the os. This condition can cause bleeding anytime during the pregnancy,  especially if a woman has contractions. If the placenta remains low lying or covering the os close to delivery, cesarean section is planned to reduce bleeding risks to the mother and baby.
  • Fetal problems which can sometimes be seen on ultrasound. Approximately 2% to 3% of all babies have a minor or major structural problem in development.

Preventing and Treating Pregnancy Complications

Preconception counselling is recommended for all the women who are planning for the baby, even if they don't have an existing medical condition. At this appointment doctor will recommend steps that can be taken to reduce the risk of certain problems. These include:

  • Getting at least 400 micrograms of folic acid daily, beginning one month before and continuing through pregnancy
  • Getting proper immunisations. 
  • Eating a healthy diet and maintaining proper weight. 
  • Avoiding cigarettes, alcohol, and drugs (except for medications approved by doctor)
  • Genetic counselling, if needed in view of previous record. 
  • Certain investigations like blood group, haemoglobin, thyroid profile, viral markers, rubella, vitamin D etc to ensure good health of mother. 
  • Regular blood pressure and sugar monitoring for the mothers with history of PIH and GDM in previous pregnancy. 
  • In view of preterm labour in previous pregnancies, progesterone support will be offered. Cervical encircelage can be done if needed. 

Women with high risk pregnancy should have regular check ups and deliver in a well equipped multispeciality hospital setting, with intensive care available for both mother and baby. Under proper supervision of doctors, one can prevent and treat high risk pregnancies.