A high risk pregnancy occurs when both mother and the developing fetus is at risk for possible complications during or after pregnancy and delivery.
A pregnancy can be identified as high-risk for different reasons. Factors often involve either maternal or fetal reasons.
Below are four common factors associated with high-risk pregnancy.
An untreated case of urinary tract infection results to pyelonephritis.
This condition occurs when the infection already involves the upper urinary system (your kidneys and ureters).
Pyelonephritis increases your risk of the following:
- Preterm labor
- Premature rupture of the membranes
- Neonatal respiratory distress syndrome
This condition is the most common nonobstetric reason of hospitalization during pregnancy.
- Genital Tract Problems
Structural abnormalities of the cervix and uterus, such as bicornuate uterus and uterine septum will put you at a higher risk for complications such as dysfunctional labor, fetal malpresentation, and the need for cesarean (C-section) delivery.
Cervical insufficiency otherwise known as cervical incompetence occurs when the uterine cervix is incapable of retaining the pregnancy during the second trimester due to the absence of uterine contractions. As a result, preterm delivery becomes more likely to occur.
According to statistics, overt diabetes occurs in about 6 percent of pregnancies.
On the other hand, about 8.5 percent of pregnant women develop gestational diabetes.
Incidence is found to be rapidly increasing due to increased obesity cases.
Preexisting insulin dependent diabetes increases the risk of the following pregnancy complications:
- Fetal death
- Severe fetal malformations
- Fetal growth restriction (if vasculopathy is present)
During pregnancy, your body’s need for insulin usually increases.
This is caused by the hormones made by the placenta in order to make the fetus grow.
However, these hormones also hinder the action of the mother’s insulin at the same time thereby increasing the need to produce more insulin.
Gestational diabetes increases the risk of the following:
- Hypertensive conditions
If a pregnant woman manifests risk factors on her first trimester, she will most likely be screened for gestational diabetes in her 24th to 28th week of pregnancy.
Some of the risk factors of gestational diabetes include:
- Unexplained fetal losses
- Body mass index (BMI) greater than 30 kg/m2
- History of gestational diabetes
- Family history of non-insulin dependent diabetes mellitus
- A macrosomic infant in a previous pregnancy
Exercise, dietary modifications, and frequent monitoring of the blood glucose levels help reduce the risk of any adverse fetal and maternal outcomes.
Some women with GD may have undiagnosed DM prior to pregnancy. That said, it’s important that you will be tested for DM 6 to 12 weeks after delivery.
- Hypertension (HTN)
Pregnant women are diagnosed with chronic hypertension or CHTN if the disorder was present before the pregnancy and if it has developed before the 20th week of pregnancy.
CHTN is different from gestational hypertension, which occurs after the 20th week of pregnancy.
Either way, HTN is defined as having a systolic BP greater than 140 mmHg or diastolic BP greater than 90 mmHg on two or more occasions.
HTN increases a pregnant woman’s risk of the following:
- Adverse fetal and maternal outcomes
- Fetal growth restriction (this could be due to decreased uteroplacental blood flow)
If you have been diagnosed with high blood pressure, you are likely to experience high risk pregnancy. With that in mind, it is crucial for you to talk to a healthcare provider first regarding the possible risk factors during pregnancy.
Once you become pregnant, prenatal care usually starts at the earliest possible time. Often, this involves measuring your baseline renal function, taking funduscopic examination, and cardiovascular evaluation (e.g. echocardiography and ECG.)
During each trimester, your doctor will recommend that you take tests that will measure and determine your Hct, serum uric acid, creatinine, 24-hr urine protein, and serum uric acid.
As for the baby, ultrasonography will be performed to observe his or her growth. This is usually done on week 28 and every 4th week after that.
Likewise, delayed growth is evaluated with the use of multivessel Doppler testing. This is usually performed by a maternal-fetal medicine specialist.