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A High-Risk Pregnancy Needs Extra Care and Attention

HIGHLIGHTS:

  • Sometimes, a medical condition such as Iron deficiency anaemia, Gestational diabetes or Preeclampsia develops during pregnancy, or it could be a result of a history of preterm birth. Twins or multiple births also categorizes the pregnancy as high risk.
  • If you are already pregnant and have higher risks, your obstetrician will recommend you a maternal-fetal medicine specialist so together they can closely observe your pregnancy.
  • A major risk for preterm delivery is preeclampsia, a pregnancy complication that can be detected from high blood pressure and signs of kidney and liver damage which usually develops after the 20th week of pregnancy.

A High-Risk Pregnancy Needs Extra Care and Attention

As a couple, you’re likely to go through an emotional roller coaster upon being told that your pregnancy has high risks. Give yourself time to feel how you do, it’s normal. However, understand that this may just mean that you need extra care and observation to have a healthy pregnancy.

Factors that make a pregnancy high risk

Approximately 6 to 8 percent are high-risk pregnancies. It could be because of the mother’s age of being under 17 or 35 and above, her lifestyle or preexisting health condition such as high blood pressure or diabetes. Sometimes, a medical condition such as Iron deficiency anaemia, Gestational diabetes or Preeclampsia develops during pregnancy, or it could be a result of a history of preterm birth. Twins or multiple births also categorizes as high-risk pregnancies. Each pregnancy is unique, and hence it’s risk level, but with the regular prenatal visits, screenings and treatments where needed, the chances of preterm delivery can be significantly reduced. In fact, since Samitivej Hospital opened its Preterm Prevention Clinic, they have been able to reduce preterm birth by 50% (compared to the WHO’s target).

Importance of making a preconception visit

Ideally, you should visit your obstetrician even before you start trying to conceive, in order to get a thorough background history check and preconception care for a healthy pregnancy. To promote parents-to-be to come for a pre-pregnancy checkup, the Preterm Prevention Clinic uses the ‘3P concept; Prediction, Prevention and Promotions of Health’ so that the process of reducing preterm deliveries begins with predicting it. If you have had a history of preterm births and a high-risk pregnancy is predicted, your obstetrician can help you achieve optimal health before pregnancy begins, placing your pregnancy under observation and advising you on the diet, exercise and lifestyle you should incorporate, and folic acid supplements where needed.

Prenatal screenings for risk of preterm birth

The most common high-risk pregnancy factor found is a previous history of preterm deliveries. Hence all pregnant women should undergo screening that includes having the cervix length measured. If it is less than or equal to 25 millimeters, this is a warning sign. There’s also a swab test to monitor for fetal fibronectin, a substance found between the amniotic sac and the endometrium. If detected, it indicates that the mother is likely to give birth prematurely. If a mom-to-be has any of these risk factors, a natural progesterone medication is given to prevent uterine contractions. In some cases, a cervical pessary or cervical cerclage is needed to increase the strength of the cervix. These simple screenings and treatments can go along way in preventing preterm delivery.

Preeclampsia – a major cause of preterm birth

Another major risk for preterm delivery is preeclampsia, a pregnancy complication that can be detected from high blood pressure and signs of kidney and liver damage, which usually develops after the 20 weeks of pregnancy. It occurs in about 3-7% of pregnancies, and most pregnant women with preeclampsia can have healthy babies, provided it is timely diagnosed as the only cure is delivery. If left undiagnosed, preeclampsia can lead to serious complications for both mother and child. Hence, in some cases the preterm delivery may need to be as early as 20 weeks, requiring a skilled maternal-fetal medicine specialist, who have three additional years of training in high-risk pregnancies, as well as a fully equipped NICU.

Placing your pregnancy under the care of a maternal-fetal medicine specialist

If you are already pregnant and have high risks, your obstetrician will recommend you a maternal-fetal medicine specialist so together they can closely observe your pregnancy. Every high-risk pregnancy is unique and requires personal care. Samitivej Hospital’s maternal fetal medicine specialists along with their team are dedicated to providing the care needed to reduce the risk of preterm delivery. The Preterm Prevention Clinic, as the name suggests, aims to promote healthy pregnancies and deliveries by investing in continuous research and the latest medical advancements in order to offer world-class medical facility to the parents-to-be. Since the opening of the Preterm Prevention Clinic, 37% of all pregnancies under their care have been high-risk pregnancies because of the trust, high-risk pregnancy parents-to-be have placed, on the skilled team of doctors, nurses, midwives and latest equipment and facilities of the hospital.

If you are planning to give birth abroad

If you are abroad or in a different city, you can email queries or concerns about your pregnancy to the Preterm Prevention Clinic explaining your condition, so that a maternal-fetal medicine specialist can be assigned based on your particular case. You can then share all your high-risk pregnancy reports with your assigned specialist, and depending on the care and observation your pregnancy requires and the facilities available in your hometown, you may or may or may not need to visit for a check-up or tests prior to delivery. If the facilities in your city are adequate for your care, Samitivej’s maternal-fetal medicine specialist and your obstetrician can be in touch to discuss your pregnancy progress and care, with you needing to come to Bangkok only approximately on the 34th week to prepare for delivery. More about giving birth in a foreign country.

Knowing What to Expect, and When to Travel

For some parents-to-be, cases may be simpler and they may only need to travel for delivery, however, for some, a specialist needs to be closely available all the time. One such case was of the parents with mono-amniotic or MoMo twins, meaning the twins share the same amniotic sac within their mother’s uterus. As these pregnancies have significantly higher risks, the parents found it hard to find a specialized doctor but Assoc. Prof. Boonsri Chanrachakul, M.D., Ph.D at the Preterm Prevention Clinic knew exactly how to handle their case. They needed to meet with the doctor daily, and he was available for them, providing the answers to all the questions and concerns they had. More about the case.

In the case of a Preterm Delivery

A maternal-fetal medicine specialist, along with your Obstetrician will monitor your prenatal care so you can have a safe and healthy pregnancy. Although they will work towards you having a full-term delivery or delaying the preterm as many weeks as they safely can, preparations will be made if the need for a preterm delivery arises. In the case of premature delivery, doctors will issue steroids to stimulate the lungs of the infant and prevent brain hemorrhaging. Only then will they allow the infant to be born and enter preterm natal care in the Newborn Intensive Care Unit (NICU) room which is fitted with the latest medical equipment for treating newborns requiring intensive care and staffed by neonatologists around-the-clock managing even the most complex cases from high risk, premature, twins or multiple births. It is even possible for babies born at as early as 23 weeks to survive, with the medical advancements now available at the Preterm Prevention Clinic.

Staying Positive and Trusting the Process

As parents-to-be, the best you can do is put your pregnancy under the care of a hospital that is fully equipped for high-risk pregnancies and a team of doctors you trust, so you can be more relaxed. Remember if you are happy, your baby will be healthier. Shift your focus to enjoy the pregnancy process as much as possible, whilst at the same time, allowing yourself time to feel low or scared when you need to. Talk to your loved ones who will just listen without trying to solve or advice you. Support one another as a couple, and remember if there is a chance of everything turning out normal, that means there is a chance of everything turning out normal.


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Assoc. Prof. Boonsri Chanrachakul, M.D. Summary: Obstetrics And Gynaecology Maternal And Fetal Medicine