High-risk pregnancy can fit into several situations. Normally, a smooth pregnancy is when the pregnant woman goes through it without major problems, such as no increase in blood pressure, falls, pre-eclampsia, and several other issues.

However, there are cases in which prenatal care must be reinforced because the pregnant woman may have health problems and even the baby may have problems detected through exams such as ultrasound, for example.

Diseases that can make a pregnancy high risk are increasingly common, both because women are getting pregnant later in life and due to lifestyle factors. Health issues can appear even before pregnancy, while others become ill during pregnancy. Examples of diseases that can lead to a high-risk pregnancy include:

Hypertension

When a woman already has high blood pressure problems even before becoming pregnant, the pregnancy is considered high risk. GHDP (Gestational Hypertensive Disease of Pregnancy) is the way high blood pressure presents during pregnancy, which is why prenatal care should be closely monitored by the obstetrician gynecologist. Pre-eclampsia is the main concern for doctors during the pregnancy of women with hypertension1. It affects 1 in every 1,500 women in Brazil. For this reason, exams such as proteinuria, urea, potassium, among others, should be part of the routine exams in high-risk prenatal care.

Diabetes

A diabetic woman should have prenatal care for a high-risk pregnancy. Strict control of blood glucose considerably reduces problems that may arise with diabetes during pregnancy. Diabetic women may give birth to large babies, as can women who have gestational diabetes2, which is specific to that pregnancy.

But not all high-risk pregnancies are caused by health issues. Some women may have a high-risk pregnancy due to the particularity of their situation. Women expecting twins or multiples are considered to have a high-risk pregnancy by doctors. This is because the uterus is under different conditions than what it is usually prepared for. The uterus was designed to carry one baby at a time, and when there are two, three, or sometimes even more fetuses, the pregnancy becomes delicate and requires the maximum care from the doctor for the mother.

In multiple pregnancies, the uterus expands much more than in a single fetus pregnancy. Usually, the uterus can expand to 20 times its original size, and in a twin pregnancy, it can reach 25 times its size! The risk of uterine rupture also arises in women with previous cesarean sections. Typically, the doctor would recommend a maximum of three cesarean deliveries—after the fourth, there is a serious risk of rupture with any sign of labor. Since the incisions are made very closely together on the uterine wall, it can become very thin and prone to rupture.

Other Problems Leading to High-Risk Pregnancy

Another case considered a high-risk pregnancy is women with different uterine conditions, such as didelphic (a woman who has two uteri and two cervices), bicornuate (a uterus divided in two, but with only one cervix), or septate uterus (a uterus with a wall dividing it in half). The greatest risk for these women is not being able to carry the pregnancy to term, but with advances in medicine and exams, the doctor can identify the problem early in pregnancy and properly treat the risk of preterm birth.

Other Problems

Cervical insufficiency leads to a high-risk pregnancy because the cervix cannot withstand the weight of the pregnancy and opens early, leading to preterm birth3.

A woman with cervical insufficiency should have a cerclage procedure around the 12th week of pregnancy and maintain complete bed rest throughout pregnancy. Women who have problems with true contractions throughout the pregnancy are also considered high risk. These contractions are the initial phase of labor and can be controlled with medication during the months of pregnancy when they occur and pose a risk.

Placenta previa is also a factor for high-risk pregnancy due to bleeding throughout the pregnancy. However, of lesser relevance, placenta previa would only cause problems if the patient wants a vaginal delivery.

Placenta Previa

If the placenta previa is complete, it will prevent vaginal delivery. A considerable increase in amniotic fluid or a decrease can also characterize the pregnancy as high risk. For this, the doctor should closely monitor the increase in fluid (polyhydramnios) and even more so in cases of fluid loss, as it can lead to the death of the baby and a risk of infection for both mother and baby4.

Very young teenagers are also considered to have a high-risk pregnancy, for example, a 12-year-old girl who is pregnant has not yet fully developed her reproductive system, so she must be monitored closely.

Mature Women

Women over 38 years old are also considered as potentially having a high-risk pregnancy. It is important to remember that the body is prepared for pregnancy up to the age of 35, when the risk of diseases is lower due to the quality of the eggs.

Moms with kidney problems, heart disease, hepatitis, and transmissible diseases such as HIV and syphilis are considered high risk and should therefore have prenatal care with a doctor specializing in high-risk pregnancies. A history of recurrent miscarriages is a factor that is considered and seen as high risk by the gynecologist.

The doctor will certainly closely monitor the pregnant woman who has had previous miscarriages. Women with thrombophilia (a blood disorder that causes thrombosis) are also considered high risk.

Women with high-risk pregnancies should have exams constantly. While in a normal pregnancy, a woman has about five ultrasounds, a high-risk pregnancy can require 10 or 12 ultrasounds per pregnancy.

Doppler ultrasound is the most requested by doctors, as it monitors the blood flow from the placenta to the baby. Blood tests are done every two months, as are urine tests.

Author’s Note

At 23 weeks of pregnancy, I was diagnosed with gestational diabetes. My baby was too big for the gestational age. Without any further testing, there I went with a referral to the high-risk prenatal doctor! Getting there, scared and insecure, I had the best surprise ever!

After a glucose tolerance test, I was not at high risk but continued my prenatal care right there. I was very well taken care of and with Dr. Patricia I had the best prenatal care possible.

High-risk doctors are all well-trained and do everything to make the mother feel calm and safe. If I could, I would make it a law that all obstetricians should be trained for high-risk pregnancies, so that pregnant women would always be in good hands!

Have you been referred to high-risk prenatal care? Don’t worry, you will be in excellent hands!

See also: Cervical Insufficiency and Cerclage: A Delicate Pregnancy