Managing high risk pregnancies

Every parent hopes for a smooth sailing pregnancy and delivery. However, there are some conditions that confer higher than usual risks for the mother and the foetus during pregnancy and delivery.

Termed as high risk pregnancies, Dr Chee Jing Jye, Obstetrician & Gynaecologists at Parkway East Hospital shares what these conditions are and how to prevent such pregnancy complications.

What are the factors that cause high risk pregnancies?

There are many conditions. Some are obvious, such as high maternal age, while there are also other conditions which are undetected unless diagnosis is done. Fortunately, if managed properly, many high risk pregnancies still end up with successful deliveries.

All conditions that increase the risk of complications in pregnancy and delivery can be categorised into two types:
Maternal factors arise from the mother, and include extremes of age (younger than 15 or older than 35); history of complications in previous pregnancies including repeated miscarriages, preterm delivery, stillborn, small- or large-for-gestation age baby; history of illnesses such as epilepsy, high blood pressure, chronic renal disease, uterine fibroids, family history of diabetes, abnormal babies and so on.

Foetal factors arise from the unborn child, including multiple pregnancies like twins or triplets; maternal exposure to infections such as (rubella, chicken pox, etc.) and addictive substances (cigarette smoke, alcohol, illegal drugs, etc.), medication which are harmful to foetus (warfarin, noresthisterone); and foetuses that have been diagnosed to have serious health problems, such as congenital heart defect.

How do we prevent them?

Preconception screening by a gynaecologist is recommended for every woman who is planning for pregnancy, especially if she has a medical problem or history. The gynaecologist will discuss with the patient on how these conditions will affect future pregnancies.

For example, women with pre-existing medical conditions may need to change their current medication. It will also help them understand the impact both ways: How the condition will affect pregnancy, and vice versa. For women with history of abnormal babies, antenatal diagnosis will provide important information in understanding the causes, and also the likelihood of recurrence.

A woman who has not done a pre-pregnancy check should consult a gynaecologist as soon as she knows she is pregnant. An ultrasound scan will help confirm if the foetus is developing well, and allow the gynaecologist to check for potential risks and recommend risk-mitigating actions.

Case Study: Stay Vigilant

One of Dr Chee's patients had a relatively uneventful first delivery, save for the caesarean operation as the foetus was in breech position. The patient's second pregnancy was smooth sailing - at least in the first half of the pregnancy.

When she was into the eighth month of her pregnancy, she realised one day that her foetus had not moved at all for a couple of hours. Thinking that the foetus may be sleeping, she monitored for a while. But when there was no foetal movement for 12 hours, she decided to go to the clinic for a check.

Dr Chee diagnosed the foetus to be of 'non-reassuring foetal status'. This is a broad term to say that the foetus is critically ill, and expedient delivery is required to save the baby. Fortunately, the patient heeded the advice, and underwent emergency caesarean section even though the baby was premature.

During the operation, it was discovered that she had adruptio, a condition where the placenta had detached from the uterine wall. When that happens, the foetus is deprived of oxygen, blood, and other essential nutrients. Her baby was literally saved in the nick of time.

Abruptio usually happens to pregnant women who have very high blood pressure, have suffered blunt trauma to the uterus or whose pregnancy is complicated by excessive amniotic fluid. Yet, Dr Chee's patient had none of the above conditions. This is a classic case of how complications can strike the least expected candidates, and how maternal instinct and vigilance can make the difference.

If anything can happen to anyone, how should we approach pregnancy?

Pregnancy is a natural physiological process in life, so there is really no need to regard it as a disease or be overly-cautious. Neither should one swing to the other extreme and assume everything will be okay. Simply by doing regular antenatal checks, one can be assured that pregnancy is progressing smoothly.

Early detection is always better, and if any complication should arise, proper management can be implemented in a timely manner to ensure the safety of both mother and foetus. When the well-being of both mother and child are maintained, one can truly enjoy the wonderful experience of pregnancy.

Publication of article by courtesy of Dr Chee Jing Jye, Obstetrician & Gynaecologist at Parkway East Hospital