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A high risk pregnancy is one where in the mother and/or baby is/are at a higher risk than normal. Today, with rise in the incidence of medical disorders (such as hypertension and diabetes) at a younger age, more and more pregnant women fall into the high
Examples include :
• Women with high blood pressure, diabetes, heart disease or kidney disease
• Rh negative women with Rh positive partner
• Elderly mother (more than 35)
• Restricted growth of baby (Growth retarded fetus)
• Decreased fluid in bag (oligohydramnios)
• Increased fluid in bag (polyhydramnios)
• Leaking or premature rupture of bag of waters
• Premature labour pains
• Premature opening of the os (the cervix or the mouth of the uterus)
• Women who have had previous loss(es)
The role of the doctor is to identify and manage these conditions and take her pregnancy to term (at least 8 complete months if possible) so that the baby is able to survive outside the womb while keeping the mother safe.
The expectant mother needs about two prenatal visits in the first trimester, monthly visits in the second trimester and fortnightly later. In the last month, weekly visits are better to keep a closer watch. But more frequent visits are mandatory in high risk patients. It is imperative that the patient religiously follows the doctor’s advice to avoid complications.
High risk pregnancy requires special care and attention and many investigations (often repeatedly) leaving the woman and her partner stressed and baffled. Many of these cases end up in caesarean section and many of the babies in the neonatal intensive care unit. Unfortunate outcomes may occasionally result.
In order to understand how the baby is affected in the high risk pregnancy, we must first understand how the baby gets its blood flow from the mother.
The placenta is a circular organ which is attached to the inner aspect of the uterus and supplies blood from the mother to the fetus (baby) via the umbilical cord. If the blood vessels of the placenta are narrowed down or blocked, the baby does not get proper blood supply. The baby and the cord are enclosed within fluid in the uterus which cushions the cord from compression. (diagram) In labour, with increasing contractions, the umbilical cord is subjected to pressure and blood flow to the baby may get reduced to some extent. However, the normal healthy baby with adequate fluid can withstand this stress without any harm.
While each condition affects the baby in different ways, the usual mechanism by which the baby suffers is that it gets less blood supply from the placenta, which gradually cuts off its lifeline and slowly deprives it of oxygen required for growth and ultimately survival, unless the disease condition is controlled or the baby delivered by intervening. Many such babies are too weak to withstand labour and need to be delivered by caesarean section and shifted immediately to the intensive care unit.
• Regular prenatal visits
• Treatment of the underlying condition (e.g. control of BP, controlling diabetes)
• Admission to hospital whenever indicated for control of disease or for better monitoring
• Monitoring the mother’s condition and response to the above treatment
• Monitoring the progress of the baby in the womb (by examinations and various tests like ultrasonography, Doppler and Non stress tests)
• Counselling of the couple at every step so that they understand the risks as well as the implications and obtain their cooperation.
• Timely delivery of the baby (in the face of imminent danger to the baby or mother, preferably after the baby is mature enough to survive in the NICU)
• Caesarean delivery in indicated cases
• Team approach by health care set up (Team of obstetrician, physician if indicated, perinatologist, neonatologist and sonologist)
• Access to facilities for immediate shifting of the baby to the NICU (preferably in the same hospital)
• Access to facilities for intensive care for the mother in serious cases (uncontrolled BP or heart disease)
Today, in most cases, with commitment and team approach as well as cooperation by the couple, a good outcome is possible in most cases.