Pregnancy is a unique but normal physiological episode in a woman’s life. However, sometimes pre-existing or unexpected illness of the mother or the foetus may result in a complicated pregnancy.
While all pregnancies have some level of risk associated with them, not all risks are equal. A pregnancy is considered high risk only when there are potential complications that could hamper the health of the mother, the baby or both. These require management by specialists to ensure that both the mother and the baby have the best outcome.
It is important to note that women, who are diagnosed with high-risk issues, mostly go on to have a normal pregnancy and a healthy delivery.
Conditions That Put You Or Your Baby At Higher Risk
ADVANCED MATERNAL AGE: PREGNANCY AT AND AFTER 35 YEARS:
In the last few decades, there has been a trend toward deferred childbearing, especially among healthy, well educated women with career opportunities. Earlier, pregnant women aged 35 and older tended to have several unplanned children whereas today the proportion of first births to such women is growing.
LIFESTYLE CHOICES: SMOKING, DRINKING ALCOHOL AND USE OF ILLEGAL DRUGS
OBESITY OR PREVIOUS HISTORY OF BARIATRIC SURGERY:
Ideally an obese woman should be encouraged to lose weight before or after pregnancy. Obese women face difficulties in getting accurate scanning done, and also have a higher chance of developing gestational diabetes, hypertension, big babies and poor progress in labour. However, dieting to lose weight is not advisable during pregnancy because it is difficult to achieve and offers no benefit to the mother. It may, in fact, have ill effects on foetal weight and health after birth.
FAMILY HISTORY OF GENETIC DISORDERS
HISTORY OF PREVIOUS BABY AFFECTED BY CONGENITAL ANOMALY
HISTORY OF RECURRENT MISCARRIAGES:
Recurrent miscarriage affects 1% of the population and is defined as three or more consecutive pregnancy losses. The majority of miscarriages occur early in pregnancy before 12 completed weeks of gestation. The incidence of late miscarriage in the second trimester between 13 to 23 completed weeks is estimated at 2%.There are several causes of recurrent miscarriages. Historically they have been grouped into genetic, anatomic, infective, endocrine, immune, environmental, thrombophillic disorders and unexplained categories.
PREMATURE LABOUR:
Labour that begins before the 37th week of pregnancy, the point at which the baby is deemed full-term is premature labour. Although there is no sure shot way to know who will experience premature labour or birth, there are factors that place women at a higher risk for developing certain infections and complications.
MULTIPLE PREGNANCIES:
The incidence of multiple births has increased remarkably over the past few decades. Multiplets have a more complicated intra uterine environment than that of singletons. It is essential to evaluate multiple pregnancies well to identify congenital anomalies and pick up early signs of intrauterine growth restriction. Monochorionic twin pregnancies share identical genetic constitution and share a single placenta with their circulations connected through vascular communications in the placenta. Such pregnancies have to be monitored well in a tertiary care centre with good foetal surveillance.
PLACENTA PREVIA:
This is a condition in which the placenta covers the cervix. The condition can cause bleeding, especially if a woman has contractions. If the placenta still covers the cervix close to delivery, the doctor may schedule a Caesarean section to reduce risks to the mother and baby. If the bleeding gets very heavy and does not respond to the surgical measures, specialists at The Nest perform what is called as ‘Uterine Artery Embolisation’. This procedure involves using a foreign material that temporarily blocks the blood supply to the uterine body, preventing excessive bleeding.
FOETAL PROBLEMS:
These problems can be detected during an Ultrasound. Studies suggest that 2-3% of all babies have minor or major structural problems in development. A family history of foetal problems may be the cause, but these problems often surface unexpectedly.
AMNIOTIC FLUID ABNORMALITIES:
Amniotic fluid surrounds the foetus after the first few weeks of gestation. This has antibacterial properties which protect the foetus and umbilical cord from compression, and serves as a reservoir of water and nutrients. Oligohydramnios is a decreased amount of amniotic fluid affecting 3 to 5% of pregnancies. Its causes include foetal growth restriction, premature rupture of membranes, foetal anomalies and maternal dehydration. Women who develop this in the second trimester have a poor prognosis with 90% perinatal mortality while women who develop this condition in the third trimester have a better prognosis with 85% perinatal survival. Such cases need to be managed in a tertiary care centre with frequent foetal surveillance. Polyhydramnios or excessive accumulation of amniotic fluid around the foetus occurs in 1 to 3% of pregnancies. The causes may be due to maternal diabetes, foetal anomalies, foetal anaemia or placental tumours. If all these causes are ruled out, there may be no underlying problem detected. Such women may face a risk of premature delivery or abnormal foetal presentation in labour.