What is a High-Risk Pregnancy?

A high-risk pregnancy involves potential risks that could lead to health issues, complications, or mortality for either the mother or the foetus during the pregnancy or the childbirth period.

Factors Contributing to a High-Risk Pregnancy

Specific elements can increase the likelihood of a high-risk pregnancy. These include:

  • Previous miscarriages or neonatal death shortly after birth
  • Preterm or post-term pregnancies
  • Having had two or more miscarriages
  • Prior history of low or high birth weight newborns
  • Slow foetal development
  • History of giving birth to a child with intellectual disabilities
  • Past experience with preeclampsia
  • Previous surgeries in obstetrics and gynecology, such as a hysterectomy
  • Carrying multiple foetuses
  • Unusual foetal position from 34 weeks onward
  • Mother's age below 16 or above 40
  • Unexplained vaginal bleeding during pregnancy
  • Rh-negative blood type
  • Development of pelvic mass during pregnancy
  • Maternal hypertension
  • Insulin-dependent diabetes
  • Pre-existing kidney or heart diseases
  • Substance abuse, including drugs and alcohol
  • Various internal medical conditions like anemia, hyperthyroidism, lupus, thalassemia, epilepsy, tuberculosis, etc.
  • Presence of HIV/AIDS, sexually transmitted diseases, or being a hepatitis B carrier

Importance of Medical Consultation

Pregnant women or those considering pregnancy with risk factors should consult experienced medical professionals in well-equipped healthcare facilities for appropriate and safe medical care.

Diagnosis of a High-Risk Pregnancy

Upon initial prenatal visits, healthcare providers will evaluate an expectant mother's likelihood of experiencing a high-risk pregnancy by:

  • Urinalysis for sugar and protein. Excessive protein in urine and high blood pressure can indicate preeclampsia, while elevated sugar levels in the urine can be a sign of gestational diabetes. Doctors will conduct further blood sugar level tests to confirm diabetes.
  • Weight and height assessment
  • Blood pressure measurement
  • Fundal height measurement
  • Additional tests and assessments as advised

Monitoring and Assessments for High-Risk Pregnancies

Expectant mothers with high-risk pregnancies should receive regular prenatal care and monitoring. They should have more frequent appointments with their doctor and may need additional tests for fetal abnormalities. Examples of fetal monitoring and assessment methods include:

  • Fetal ultrasound – An ultrasound is a non-invasive test that utilizes high-frequency sound waves to assess the condition and gather information about the pregnancy. It provides insights into any potential issues with the fetus, placenta, and uterus, as well as the overall morphology and physiology of these structures. Importantly, this diagnostic procedure poses no harm to either the mother or the fetus.
  • Prenatal screening for Down’s syndrome can be done in a variety of ways, such as
  • Screening Options for Down's Syndrome: Various methods are available for detecting Down's syndrome, including:
    • Initial Trimester Combined Screening: Conducted between the 11th and 13th weeks of pregnancy, this screening merges a special ultrasound known as nuchal translucency (NT) with a blood examination. It has an 85% detection rate for Down's syndrome and a 5% rate of false positives.
    • Quadruple Blood Test in the Second Trimester: For those who start prenatal care later, this blood test is available between the 15th and 20th weeks of pregnancy. It also detects Down's syndrome in about 85% of cases, with a 5% false-positive rate.
    • Non-Invasive Fetal Trisomy (NIFTY) Test: Utilising cutting-edge genetic sequencing technology, this test scans the cell-free fetal DNA in the maternal blood for Down's syndrome. With an accuracy rate of over 99% and less than a 1% false-positive rate, it can be done anytime after the 12th week of pregnancy. Results are usually ready in 2-3 weeks following the blood sample collection.
    • Amniotic Fluid Analysis (Amniocentesis): Typically performed between the 18th and 20th weeks of pregnancy, this procedure tests fetal cells to diagnose various conditions, including chromosomal irregularities and genetic disorders like thalassemia.
    • Additional Specialised Prenatal Examinations: Depending on your healthcare provider's advice, other tests such as Chorionic Villus Sampling (CVS), Percutaneous Umbilical Blood Sampling (also known as cordocentesis), or Non-Stress Tests (NST) might be recommended.

Preventative Measures and Treatment

Taking care of oneself during pregnancy is crucial for the safety and well-being of both the baby and the mother. By giving proper attention to health and well-being, expectant mothers can ensure a happy and healthy pregnancy. It's important to note that prenatal self-care may vary depending on the individual circumstances of the mother and the unborn child. Consulting with a doctor is essential to determine the appropriate approach. Here are some important practices for expectant mothers to consider:

  • Preparing for pregnancy: Before getting pregnant, both the mother and father should undergo pre-pregnancy health check-ups. If any health issues are identified, it's important to take the necessary steps to treat or manage them before conceiving. For example, individuals with high blood pressure should work towards maintaining a normal range before getting pregnant. Overweight individuals should aim to lose weight through a healthy diet and exercise.
  • Taking folic acid: Those planning on getting pregnant should start taking folic acid supplements 2-3 months before conception to prevent birth defects such as spina bifida or other neural tube defects.
  • Antenatal care: Once pregnancy is confirmed, it's important to inform the healthcare provider about any medical history or pre-existing conditions. This will help in planning appropriate care and treatment throughout the pregnancy. Regular scheduled appointments with the doctor should not be missed.
  • Avoiding harmful substances: Smoking, alcohol consumption, and recreational drug use should be avoided during pregnancy.
  • Being cautious with activities: It's advisable to avoid travel or any activities that may have a negative effect on the fetus.
  • Regular check-ups: Urine tests, weight monitoring, and blood pressure checks should be done during every doctor's visit to monitor for any abnormalities or complications that may arise during pregnancy.
  • Maintaining a healthy bodyweight: It's important to maintain a healthy bodyweight during pregnancy, avoiding both being underweight and overweight.
  • Managing high blood sugar: Women with high blood sugar should control their sugar levels through a healthy diet and regular exercise. It's recommended to consult a physician for exercises that are safe during pregnancy and to regularly monitor blood sugar levels.
  • Stress reduction: Taking steps to reduce stress and anxiety is important for the well-being of both the mother and the baby.
  • Sufficient rest: Getting enough rest is essential during pregnancy.

Symptoms That Warrant Medical Attention

Immediate medical consultation is necessary if an expectant mother experiences:

  • Frequent headaches
  • Abdominal discomfort or cramps
  • Unusual stomach size
  • Vaginal bleeding
  • Reduced or absent foetal movements post 5-6 months of pregnancy

By being aware and taking the necessary precautions, you can manage a high-risk pregnancy with the appropriate medical intervention and support.