When a woman learns she is pregnant, it can be a time of great joy, excitement and anticipation. But , it can also be a time of anxiety, stress and worry if the pregnancy is considered high-risk. In India about 20-30 %pregnancies belong to high -risk category, which is responsible for 75% of perinatal morbidity and mortality. Early detection and effective management of high-risk pregnancy can contribute substantially in reduction of maternal and fetal adverse outcomes. High-risk pregnancies require management by a multi-disciplinary team to help ensure the best outcome for the mother and baby.
WHAT IS A HIGH RISK PREGNANCY ?
A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. These complications can arise any time before , during or after delivery.
WHAT ARE THE RISK FACTORS ?
Pre existing factors
A pre-existing heart condition .
Hypertension, Asthma, Epilepsy, kidney diseases
Obesity: BMI of 30 or higher.
TYPE 2 Diabetes
Certain Sexually transmitted infections including HIV
Autoimmune diseases like SLE
Blood disorders like sickle cell disease
Family history of genetic diseases
Age more than 35 or younger than 18
Lifestyle factors: Smoking, drinking, or using drugs
Complications in a previous pregnancy:
Risk Factors Developed During Pregnancy :
Preeclampsia: It is a serious blood pressure disorder that can affect all of the organ’s in a pregnant woman’s body.
HELLP syndrome: This is a rare condition related to preeclampsia in which red blood cells are damaged or destroyed, which can cause the liver to bleed and clotting issues.
Multiple pregnancy : Twins, triplets
Placental complications like placenta previa, accreta, abruption which can cause severe bleeding.
Preterm labor: Delivery before 37 weeks
HOW TO IDENTIFY HIGH RISK PREGNANCIES
The best time to assess the potential impact of medical or obstetric complications on the outcome of pregnancy is before pregnancy occurs. This is known as pre conceptional counselling. This helps in identifying a significant number of high risk pregnancies. A careful history and physical examination of every obstetric patient also helps in identifying high risk pregnancies. Regular prenatal check ups also help in identifying risk at an early stage.
HOW TO PREVENT HIGH RISK PREGNANCY?
WHEN TO SEEK IMMEDIATE MEDICAL CARE IN HIGH-RISK PREGNANCY?
HOW TO MANAGE HIGH RISK PREGNANCY?
Quality prenatal care with multidisciplinary team approach helps in managing high risk pregnancies
The main objective of prenatal care is prevention and treatment of abnormal outcomes in both the mother and the baby. Quality prenatal care includes accurate estimation of dates, detailed history of the mother and certain investigations to rule out any high risk factors, screening tests to rule out chromosomal abnormalities, obstetric scans by fetal medicine specialists, regular antenatal visits with obstetrician, necessary investigations to identify high risk conditions, multidisciplinary approach for managing high risk pregnancies , perinatal counselling for high risk fetal conditions, fetal surveillance by NST, regular growth scans and doppler studies and finally formulating a line of management for improving maternal and fetal outcomes.
High risk pregnancy treatment varies from case to case. The type of treatment offered depends upon the type of disease, its effect on the baby, the patient’s overall health condition and more. Most of the high-risk pregnancy complications can be treated effectively if the condition is highlighted in the early stages. This is why it is more important to have regular prenatal care. Management may sometimes need involving specialists from various branches. The multidisciplinary team approach has emerged as a way of providing comprehensive medical care by bringing together professionals from a wide range of disciplines in a coordinated and effective manner to improve maternal and neonatal outcome. High risk pregnancies need to be managed in a tertiary care center where multi disciplinary team approach is possible.