High Risk Pregnancy & Complications


For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complications. But some women are at an increased risk for complications even before they get pregnant for a variety of reasons. Having a high-risk pregnancy means it’s more likely that you or your baby will have health problems during pregnancy, birth, or after delivery. These could be very minor problems, but in some cases, a high-risk condition can be life threatening for a woman or her baby. That’s why a high-risk pregnancy requires extra monitoring by your Obstetrics and Gynecology. At Fortis Hospitals, Mumbai our multidisciplinary team of gynaecologists, neonatologists, obstetricians, neonatal – nurses & staff backed by our state of the art facilities will ensure you have a safe & healthy delivery.

Causes Of A High-Risk Pregnancy

There are many factors that can make a pregnancy high-risk. If you had problems with a previous pregnancy or delivered a baby early, your next pregnancy may fall into the high-risk category as a result.

There are many conditions that can affect a pregnancy:

  • Blood disorders like sickle cell disease
  • Chronic kidney disease like preeclampsia
  • Depression includes both anxiety and depression
  • High blood pressure (untreated high blood pressure can delay the growth of your baby and lead to placental abruption)
  • HIV or AIDS (HIV or AIDS can be passed to the baby before birth)
  • Lupus
  • Maternal age
  • Obesity ( A cesarean delivery may be a necessity as a result of obesity)
  • Thyroid disease (A thyroid condition may result in having your baby early)
  • Type 1 or type 2 diabetes. Both type 1 & 2 diabetes can result in fetal macrosomia: birthing a large baby.

Ectopic Pregnancy

Normal pregnancies develop inside your uterus, after a fertilized egg travels through your fallopian tube and attaches to your uterine lining. Ectopic pregnancy is when a fertilized egg attaches somewhere else in your body, usually in your fallopian tube — it’s sometimes called “tubal pregnancy.”
 
Ectopic pregnancies can also happen on your ovary, or somewhere else in your belly.
 
Ectopic pregnancies are rare — it happens in about 2 out of every 100 pregnancies. But they’re very dangerous if not treated. Fallopian tubes can break if stretched too much by the growing pregnancy — this is sometimes called a ruptured ectopic pregnancy. This can cause internal bleeding, infection, and in some cases lead to death.

Preeclampsia/ Hypertension

High blood pressure can cause problems the mother and unborn baby.The expectant mother may get high blood pressure before she was pregnant or she may get it once she are pregnant – a condition called gestational hypertension.Either one can cause low birth weight or premature delivery of the baby.Controlling blood pressure during pregnancy and getting regular prenatal care are important for the health of both the baby & the mother. Treatments for high blood pressure in pregnancy may include close monitoring of the baby, lifestyle changes, and certain medicines.
 
Some pregnant women with high blood pressure develop preeclampsia. It’s a sudden increase in blood pressure after the 20th week of pregnancy. It can be life-threatening for both you and the unborn baby. There is no proven way to prevent it. Most women who have signs of preeclampsia are closely monitored to lessen or avoid complications. The only way to “cure” preeclampsia is to deliver the baby.
 
Miscarriage
 
A miscarriage is the loss of your baby before 20 weeks of pregnancy. The loss of a baby after 20 weeks is called a stillbirth.
 
Up to 1 in 5 confirmed pregnancies end in miscarriage before 20 weeks, but many other women miscarry without having realised they are pregnant.

Common signs of miscarriage include:

  • Bleeding which progresses from light to heavy
  • Severe cramps
  • Abdominal pain
  • Fever
  • Weakness
  • Back pain

 
Many women experience vaginal spotting in the first trimester that does not result in pregnancy loss.

Occasionally, miscarriage are caused by:

  • Hormonal abnormalities
  • Immune system and blood clotting problems
  • Medical conditions such as thyroid problems or diabetes
  • Severe infections causing high fevers (not common colds)
  • Physical problems with your womb or cervix.
  • Risk factors for miscarriage

Prevention of miscarriage

Living healthily – no cigarettes, no alcohol and little to no caffeine – can decrease your risk of miscarriage

Gestational Diabetes

Gestational diabetes is high blood sugar that develops only during pregnancy and usually disappears after giving birth.It can occur at any stage of pregnancy, but is more common in the second half.It occurs if the expectant mother’s body cannot produce enough insulin to meet the extra needs in pregnancy. Gestational diabetes can cause problems for the mother and the baby during and after birth. In India itself there are reports of more than 1 million cases of gestational diabetes.

Treatment

To treat gestational diabetes, the Obstetrics and Gynecology will advise the expectant mother

  • Check  blood sugar levels four or more times a day.
  • Do urine tests that check for ketones, which mean that your diabetes is not under control
  • Eat a healthy diet
  • Make exercise a habit

 
Low Lying Placenta (Placenta Previa)
 
Placenta previa, or low-lying placenta, occurs when the placenta covers part or all of the cervix during the last months of pregnancy. This condition can cause severe bleeding before or during labor.If the placenta attaches instead to the lower part of the uterus, it can cover part or all of the cervix. When the placenta covers part or all of the cervix during the last months of pregnancy, the condition is known as placenta previa, or low-lying placenta. Most women with this condition will require bed rest.
 
Symptoms associated with placenta previa
 
The main symptom is sudden light to heavy bleeding from the vagina, but if any of the symptoms below occur, you should seek immediate medical attention:
 

  • Cramps or sharp pains
  • Bleeding that starts, stops, and begins again days or weeks later
  • Bleeding after intercourse
  • Bleeding during the second half of pregnancy

 
Risk factors for the development of placenta previa include:
 

  • Unusual position of the baby: breech (buttocks first) or transverse (lying horizontally across the womb)
  • Previous surgeries that involve the uterus: cesarean delivery, surgery to remove uterine fibroids, dilation and curettage (D&C)
  • Being pregnant with twins or other multiples
  • Prior miscarriage
  • Large placenta
  • Abnormally shaped uterus
  • Prior diagnosis of placenta previa
  • Age older than 35
  • Asian Ethnicity
  • Smoking

Reducing High-Risk Pregnancy Complications

If you fall into the high-risk category during your pregnancy there are things you can do to increase the health and wellness of both your unborn child and yourself and avoid pregnancy complications:
 

  • Schedule a preconception visit with your doctor
  • Find out all you can about your condition
  • Go to all your prenatal appointments
  • Have a healthy lifestyle gain the right amount of weight and stay active if you’re able
  • Ask your partner, family, and friends for support
  • Look after your emotional well-being
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