High Risk Pregnancy Management

A high-risk pregnancy might have ups and downs. Do your best to stay positive as you take steps to promote a healthy pregnancy.
Most of the time having a baby is a natural process. After a full-term pregnancy, a woman goes into labor on or near her due date and gives birth to a healthy baby. A day or two later she leaves the hospital to begin day-to-day life with her growing family. But not all pregnancies go smoothly. Some women experience what doctors refer to as a 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 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 17 or over 35 when their baby is due are at greater risk of complications than those between their late teens 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; breathing, kidney, or heart problems; diabetes; autoimmune disease; 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.

If you have a medical condition, it’s important to consult your doctor before you decide to become pregnant. Your doctor may run tests, adjust medications, or advise you of precautions you need to take to optimize the health of you and your baby.

  • Medical conditions that occur during pregnancy. Even if you are healthy when you become pregnant, it is possible to develop or be diagnosed with problems during pregnancy that can affect you and your 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. With proper management, however, most women who develop preeclampsia have healthy babies.
  • 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 treatment plan from their health-care provider. Usually the diabetes resolves 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 labor 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 certain infections, a shortened cervix, or previous preterm birth.
  • Multiple births means you are carrying more than one baby (twins, triplets, quadruplets, etc.). Multiple pregnancies, which are more common as women are using more infertility treatments, increase the risk of premature labor, gestational diabetes, and pregnancy-induced high blood pressure.
  • Placenta previa 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 cesarean section 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. Sometimes there may be a family history of fetal problems, but other times these problems are completely unexpected.

What steps can I take to promote a healthy pregnancy?

Whether you know ahead of time that you’ll have a high-risk pregnancy or you simply want to do whatever you can to prevent a high-risk pregnancy, stick to the basics. For example:

  • Schedule a preconception appointment. If you’re thinking about becoming pregnant, consult your health care provider. He or she might counsel you to start taking a daily prenatal vitamin and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your health care provider might also discuss your risk of having a baby who has a genetic condition.
  • Be cautious when using assisted reproductive technology (ART). If you’re planning to use ART to get pregnant, consider how many embryos will be implanted. Multiple pregnancies carry a higher risk of preterm labor.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Eat a healthy diet. During pregnancy, you’ll need more folic acid, calcium, iron and other essential nutrients. A daily prenatal vitamin can help fill any gaps. Consult your health care provider if you have special nutrition needs due to a health condition, such as diabetes.
  • Gain weight wisely. Gaining the right amount of weight can support your baby’s health — and make it easier to shed the extra pounds after delivery. A weight gain of 25 to 35 pounds (about 11 to 16 kilograms) is often recommended for women who have a healthy weight before pregnancy. If you’re overweight before you conceive, you might need to gain less weight. If you’re carrying twins or triplets, you might need to gain more weight. Work with your health care provider to determine what’s right for you.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. Get your health care provider’s OK before you start — or stop — taking any medications or supplements.

Do I need special tests?

If you have a high-risk pregnancy, you might consider various tests or procedures in addition to routine prenatal screening tests. Depending on the circumstances, your health care provider might recommend:

  • Specialized or targeted ultrasound. This type of fetal ultrasound — an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus — targets a suspected problem, such as abnormal development.
  • Amniocentesis. During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 15 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
  • Chorionic villus sampling (CVS). During this procedure, a sample of cells is removed from the placenta. Typically done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Cordocentesis. This test, also known as percutaneous umbilical blood sampling, is a highly specialized prenatal test in which a fetal blood sample is removed from the umbilical cord. Typically done after week 18 of pregnancy, the test can identify chromosomal conditions, blood disorders and infections.
  • Cervical length measurement. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you’re at risk of preterm labor.
  • Lab tests. Your health care provider might take a swab of your vaginal secretions to check for fetal fibronectin — a substance that acts like a glue between the fetal sac and the lining of the uterus. The presence of fetal fibronectin might be a sign of preterm labor.
  • Biophysical profile. This prenatal test is used to check on a baby’s well-being. The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound.

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. Ultimately, the decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your health care provider.

What else do I need to know about high-risk pregnancy?

Consult your health care provider about how to manage any medical conditions you might have during your pregnancy and how your health might affect labor and delivery. Ask your health care provider to discuss specific signs or symptoms to look out for, such as:

  • Vaginal bleeding
  • Persistent headaches
  • Pain or cramping in the lower abdomen
  • Watery vaginal discharge — in a gush or a trickle
  • Regular or frequent contractions — a tightening sensation in the abdomen
  • Decreased fetal activity
  • Pain or burning with urination
  • Changes in vision, including blurred vision

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