Understanding Your High Risk Pregnancy

Understanding Your High Risk Pregnancy

If your doctor has determined you have a “high-risk” pregnancy, it is because of medical conditions that don’t usually arise during a “normal” pregnancy. It means that your pregnancy will have to be managed differently and monitored more closely.

At Swedish Medical Center, we have the resources to provide extra-attentive care to you and your baby through our renowned perinatologists and our experienced and caring staff on the Antepartum Unit. So don’t let the term “high-risk” alarm you. Most women who have high-risk pregnancies go on to deliver successfully and have healthy children.

High-risk conditions

You could have any of a number of conditions that cause your pregnancy to be “high-risk,” including:

Preterm labor
Hypertension in pregnancy
Placental abruption
Gestational diabetes
Cervical incompetence
Placenta previa
Intrauterine growth restriction (IUGR)
Polyhydramnios/oligohydramnios


Preterm labor

Preterm labor is when labor occurs earlier in the pregnancy than is normal — from 20 to 36 weeks. Persistent uterine contractions cause the cervix to efface (thin) and/or dilate (open). This can result in the premature birth of the baby. Babies born more than three weeks before their due date can have serious problems breathing, feeding and keeping warm.All pregnant women are at some risk for preterm labor. The symptoms of preterm labor include:

  • Pelvic pressure (a feeling of the baby moving down)

  • Low dull backache

  • Menstrual-like cramps

  • Change or increase in vaginal discharge

  • Uterine contractions (tightenings) with or without pain

  • Intestinal cramping with or without diarrhea

Your care, whether at home or in the hospital, will involve treatment to prevent preterm delivery. Your physician may recommend full or partial bed rest, and possibly the use of medications to stop the contractions from causing further cervical change. Tests used to monitor and manage preterm labor may include ultrasound exams, blood tests, cultures and amniocentesis.

Preterm premature rupture of membranes (PPROM)

PPROM refers to breakage of the membranes (also known as the “amniotic sac” or “bag of waters”) before 36 weeks. If this happens, you will stay in the hospital on bed rest until the birth of your baby.

The length of time a pregnancy can be prolonged after membrane rupture varies greatly. Your temperature will be watched and the staff will note any flu-like signs of impending infection. Vaginal exams will be discontinued, to decrease the chance of infection that might trigger preterm delivery. A speculum exam may be performed occasionally to look at your cervix and possibly take cultures. Regular ultrasound exams and biophysical profiles will be used to assess the baby’s condition. Amniocentesis may be done to check for fetal lung maturity and infections. Antibiotics may be given, or steroids to help mature the baby’s lungs if preterm delivery is anticipated.

You will be given no medications to prevent contractions, and if labor starts it will not be stopped with medication. When it is determined the baby’s lungs are mature, your physician will induce labor.

Hypertension in pregnancy

There are several terms for this condition: pre-eclampsia, toxemia or PIH (for “pregnancy-induced hypertension”). They all refer to the same thing: high blood pressure caused by pregnancy, that appears after 20 weeks. PIH can be mild or severe. When it is severe, it affects the mother’s circulatory system, kidneys, brain and other vital organs. Pregnant women can be very sick if PIH is severe. Signs and symptoms of mild PIH:

  • High blood pressure

  • Water retention (swelling)

  • Protein in the urine

Signs and symptoms of severe PIH, in addition to the above:

  • Headaches and blurred vision

  • Inability to tolerate bright light

  • Fatigue

  • Nausea and vomiting

  • Producing less than a pint of urine in 24 hours

  • Pain in the right upper abdomen

  • Shortness of breath

The cause of PIH is not known. It appears in 5 percent of pregnant women. It is more likely to occur during first pregnancies, in women less than 25 years old, and in women more than 35 years old. Pregnant women who have chronic hypertension, kidney disease, diabetes, or who are pregnant with more than one baby have a greater chance of developing PIH.

Bed rest is the first recommendation for this condition. If your blood pressure stays high and you have elevated protein levels in your urine, the doctor may choose to admit you to the hospital to more closely watch your symptoms. Medications to lower your blood pressure may be used. If the PIH is worsening, your doctor will treat you with magnesium sulfate to prevent complications of PIH. Delivery of the baby would also be considered. The symptoms of PIH begin to go away after the delivery of the baby.

Placental abruption

Abruption of the placenta is the early separation of a normal placenta from the uterine wall. It can cause serious problems for both baby and mother. Some of the risk factors for abruption include:

  • Age 35 or older

  • Have had more than four or five children

  • Twins or triplets

  • High blood pressure

  • Cocaine/methamphetamine use

  • Diabetes

  • History of previous abruption

Symptoms of abruption are:

  • Contractions that don’t stop

  • Painful uterus

  • Tenderness in the abdomen

  • Vaginal bleeding

If abruption is suspected, your physician will recommend blood tests and an ultrasound exam. Treatment will depend on the percentage of placenta that has separated from the uterus, stage of pregnancy, amount of bleeding, the baby’s condition and the presence of other problems such as PIH.

Treatment involves the use of IV fluids, monitoring your vital signs and fetal monitoring. If your blood count is quite low, your physician may discuss with you the need for a blood transfusion.

If the bleeding stops and the abruption is stable, you may remain in the hospital for a time and then go home to bed rest. If the abruption is moderate to severe, your physician may decide to deliver your baby.

Gestational diabetes

Gestational diabetes is the inability to process carbohydrates properly, resulting in high blood sugar in both the mother and the baby. It affects 2 percent to 3 percent of all pregnancies. If you are diagnosed with gestational diabetes, you will learn how to check your blood sugar regularly with a finger stick monitor. A dietitian will give you guidelines and instruction in establishing and following a diabetic diet. Often, this is enough to treat the condition. If your blood sugars remain high, you may need to be treated with insulin.

Cervical incompetence

This is when the cervix dilates during the second trimester. Because there are no contractions or pain, you could be totally unaware it is happening. In many cases, the causes are unknown. If you have this condition, the amniotic sac may push partially into the vagina and lead to premature delivery. To prevent this from happening, your physician will most often recommend placing a cerclage or stitch in the cervix to hold it closed, and bed rest until time of delivery.

Placenta previa

Placenta previa occurs when the placenta partially or completely covers the opening of the uterus (cervix). The risk for placenta previa is greater for women who:

  • Are older than 35

  • Have had more than one previous delivery

  • Have had many abortions

  • Are carrying twins

  • Have had a previous cesarean section

  • Have had a previous placenta previa

The most common symptom is bright red bleeding, usually with no pain or cramping. Your physician will order an ultrasound exam to determine the exact location of the placenta, and blood tests to determine how much blood has been lost. Regular ultrasounds and non-stress tests will be performed to make certain the baby is well.

The treatment for placenta previa depends on how much bleeding has occurred. You may need a transfusion of blood. If you are late in your pregnancy, your doctor may decide to deliver your baby, depending on how much bleeding is occurring. If you have bleeding before your 37th week of pregnancy, you may remain hospitalized on bed rest until you are closer to term, or until the bleeding or contractions disappear. Whether you are allowed to go home or remain in the hospital, it is important to let your nurse and physician know of any further bleeding episodes. When a complete previa exists, the baby must be delivered by cesarean section.

Intrauterine growth restriction (IUGR)

This stands for intrauterine growth restriction. It means the baby is growing more slowly than is normal. The most common cause is a problem with the placenta – the tissue that carries food and blood to the baby. It can also be caused by:

  • Birth defects

  • Genetic disorders

  • Infection in the mother

  • High blood pressure

  • Smoking

  • Alcohol or drug abuse

  • Use of certain prescription medicines

IUGR doesn’t just mean a small baby. If your family has a history of small babies, it might be perfectly normal for your baby to be small. IUGR is slower-than-normal growth in a baby that should be larger, and it is diagnosed by careful measurements of the baby and the amniotic sac using ultrasound. Often the doctor will order fetal monitoring or amniocentesis to evaluate the cause of IUGR.

If your baby has stopped growing or has other problems, your doctor may decide that an early delivery is the best course. If your baby is especially fragile, the early delivery may be performed via a cesarean section to avoid subjecting the baby to the stresses of a vaginal delivery.

Polyhydramnios/Oligohydramnios

This occurs when there is too much or too little amniotic fluid. Both can cause problems with the pregnancy. Frequent ultrasound exams and fetal monitoring are usually ordered by the physician.

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