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    High Risk Pregnancy

    Pregnancy is a natural process until and unless a woman is bound with some pregnancy complications. The pregnancy is labelled high risk under certain conditions which complicates the health or life of mother and baby. Those conditions can be broadly defined as follows:



    1.Age of the mother (below 18 years and above 35 years of age)


    2.Existing health condition of the mother 


    3.Blood disorder (Rh, sickle cell)


    4.Pregnancy biology


    5.Lifestyle habits of the mother 

    1. Age of the mother (below 18yrs and above 35yrs of age)


    • Young Age ( below 18 years): Pregnancy in teenage is more prone to develop high blood pressure, anemia and a mother can also go through preterm labor and delivery. It is advised to do utmost prenatal care because it helps in evaluating, identifying and treating risks.
    • First Pregnancy above 35 years of age: In the age of 35, the first-time mother is at higher risk of certain problems than younger women such as preeclampsia, high blood pressure, gestational diabetes, pregnancy loss, delivery complication viz. excessive bleeding, prolonged labor, and no advance labor. Early and regular prenatal care helps many women to have healthy pregnancies and deliveries without complications.


    2.Existing health condition of the mother:

    

    • Diabetes, High Blood Pressure(eclampsia), thyroid status:- It is important for a mother to manage diabetes, high blood pressure and thyroid status both before getting pregnant and throughout pregnancy. Women with diabetes and high blood pressure should keep tight control of their blood sugar and pressure through exercise, yoga, and diet.
    • History of miscarriage, abortion: If you have experienced more than two following miscarriages in the past, then you might have high-risk future pregnancy. Your doctor may suggest getting a test for evaluating and recognizing any kind of fundamental causes before you try to get pregnant again.
    • Previous baby with chromosomal (Down Syndrome) or developmental disorder (Autism): If your previous baby was born with down syndrome or development disorder, it’s important to go for prenatal genetic counselling to identify any issue, once you get pregnant again. 
    • Infections HIV, hepatitis, UTI: Infection during pregnancy might be dangerous for mother and baby both. Infection may include HIV, Hepatitis, Urinary Tract Infection, etc. These infections can grow the chances of risk during pregnancy, labor, delivery, and breastfeeding. Fortunately, there are many effective treatments that can decrease and prevent the spread of infections. 
    • Underweight (<45kg) or overweight: Weight of a mother matters a lot during pregnancy. Being obese or underweight (<45Kg) before pregnancy is related to several risks for poor pregnancy results. For example, obesity increases a woman’s chance of evolving diabetes during pregnancy and underweight can cause a fetus growth which can contribute to difficult births. Ensure to monitor your pregnancy recommended weight gain whether you are obese or underweight. 


    3.Blood disorder (Rh, sickle cell)


    • RH Factor: During pregnancy, issues can happen if you’re Rh negative and the fetus you’re carrying is Rh positive. Basically, your blood doesn’t mix with your baby’s blood but there could be some chances if your baby’s blood could come in contact with your blood during pregnancy or delivery. Consult your doctor for Rh immune globulin injection during pregnancy and remind your doctor’s team of your Rh status during delivery. 
    • Sickle Cell: If we talk about blood disorder during pregnancy, sickle cell disease is a blood disorder passed down from parent to child. People with sickle cell disorder have abnormal hemoglobin (which is a protein in red blood cells that carries oxygen to the body. Early and regular prenatal checkup is important if you are pregnant and going through this disease. Ensure regular prenatal visit which allows your doctor to keep a close eye on the disease and on the health of growing baby. 


    4.Pregnancy biology 


    • Multiple Gestation: Having twins or triplets infants increases the chance that a mother will need to have the babies delivered by cesarean procedure. Having two or more babies are more likely to be smaller in size and also may increase the chances of premature delivery.
    • Placenta previa: It is a situation in which the placenta lies low in the uterus and covers the cervix. The situation can cause bleeding, specifically if a woman has contractions. If prior to delivery, the placenta still covers the cervix, the doctor may advise a cesarean section to decrease bleeding risks to the baby and mother.
    • Incompetent cervix: Incompetent cervix means your cervix dilates (opens) too early during pregnancy, basically without pain or contractions. An incompetent cervix can cause premature birth and miscarriage. It's better to consult your doctor near around 10-13 week of pregnancy to analyze the risk related to incompetent cervix. 


    5.Lifestyle habits of the mother


    • Alcohol, Smoking and Drug Usage: During pregnancy, intake of alcohol, smoke, tobacco, and drugs can increase the risk of sudden infant death syndrome (SIDs), developmental disorders, birth defects, etc. This can increase the chances of a baby’s risk for fetal disorders which have a variety of effects on the baby. It's important to ensure a healthy routine during pregnancy through regular exercise, yoga, and properly balanced diet. 


    Reference:

    Textbook of Obstetrics: DC Dutta’s (Hypertensive disorder in pregnancy, antepartum Haemorrhage, Haemorrhage in early pregnancy, multiple pregnancy, complicated pregnancy)


    Frequently Asked Questions

    ●Ensure access to obstetricians, anaesthetists and neonatologists (specialists in newborn care).

    ● Ensure that the hospital has NICU (neonatal intensive care unit) so that your baby can be transferred easily to a special care baby unit if necessary.

    ● You can have a caesarean procedure immediately if required.

    ● The hospital must be equipped with all the instruments and facilities


    A miscarriage is the pregnancy loss before the 20th week of pregnancy. Miscarriage symptoms are:


    ●  Bleeding progressing from light to heavy (early miscarriage symptom)

    ●  Abdominal pain 

    ●  Severe cramps

    ●  Back pain

    ●  Weakness 

    ●  Fever


    Most of the cases of miscarriages (also called spontaneous abortions) are random and cannot be prevented. Please consult your gynaecologist for further action. 


    In an ectopic pregnancy, the fertilized egg implant outside the uterus. It doesn’t reach the uterus and usually gets stuck in the fallopian tube. It never progresses to a normal baby. 

    The common causes include an infection or inflammation of the fallopian tube, scar tissue from previous infection or surgery, abnormal growths or birth defects. 

    Ectopic pregnancy symptoms include: 

    • Missed period 
    • Vaginal bleeding
    • Discomfort or pain in the belly 
    • Sharp abdominal cramps
    • Breast tenderness
    • Nausea and vomiting with pain
    • Dizziness 
    • Weakness 


    An ectopic pregnancy is extremely dangerous for the mother, and it should be addressed immediately. The condition should be treated as an emergency. Therefore, consult your gynaecologist on a priority basis. 


    Diabetes and hypertension before or during pregnancy constitute high-risk pregnancy loss and increases the risk of a baby with a birth defect viz. heart malformations and neural tube defects. 

    These conditions labelled the pregnancy under high-risk category and you should ensure close prenatal monitoring under the supervision of your gynaecologist. 

    A mother who has lost a pregnancy must be under huge depression and will have anxiety symptoms whenever she plans her next pregnancy. 

    Therefore, it is suggested to always consult with a genetic counsellor and undergo genetic screening before planning your next pregnancy. Moreover, consult psychologist for better recovery. 


    Stillbirth means a baby is born with no signs of life. Some common risk factors are: 

    • Diabetes
    • High blood pressure leading to eclampsia 
    • Obesity
    • Birth defects like chromosomal, genetic and structural defects
    • Infection to the mother viz. syphilis, malaria 
    • Umbilical cord accident
    • Trauma


    During pregnancy, intake of alcohol, smoke, tobacco, and drugs can increase the risk of sudden infant death syndrome (SIDs), developmental disorders, birth defects, etc. This can increase the chances of a baby’s risk for fetal disorders which have a variety of effects on the baby. It's important to ensure a healthy routine during pregnancy through regular exercise, yoga, and properly balanced diet.