High-risk pregnancy
Not all pregnancies are plain sailing. Some need close monitoring.
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Many women sail through pregnancy, suffering no more than nausea, heartburn or swollen ankles. For others, it’s not that simple.

A high-risk pregnancy means there is a larger than average chance that mother and baby will have health problems. Women over 35 are often automatically considered to be “high-risk” as age increases the chances of developing complications such as gestational diabetes and pre-eclampsia.
Because a normal pregnancy’s harmless side effects and the symptoms of complications are often quite similar, it’s important not to self-diagnose (anxious moms should stay away from Google!) Remember: every woman is different, so consult your gynaecologist or obstetrician about your own particular circumstances.

Here is a rough guide to five of the more “common” high-risk pregnancies.

1. GESTATIONAL DIABETES

WHAT IS IT? A temporary form of diabetes which appears during pregnancy, usually in the second trimester. Your blood has high levels of glucose (sugar), but your body is not making enough insulin to shift it from the blood to be stored. Insulin levels might be inadequate because the placenta is producing pregnancy hormones that block insulin’s effects. According to the US Institute of Child Health and Human Development, about five percent of women will contract gestational diabetes.

WHO’S AT RISK? Over 35s, overweight or obese women; smokers, those with a family history of late-onset diabetes, women who’ve had several babies, a large baby (over 4kgs) or those who have previously had gestational diabetes during pregnancy.

THE DANGERS Baby’s growth may be affected – s/he may be too large, be born with low blood sugar, be jaundiced or have difficulty breathing and require oxygen. Moms might develop pre-eclampsia and, if baby is too big, need a caesarean.

SYMPTOMS Sugar in your urine (this is why your doctor will do frequent urine tests). Thirst, frequent urination and fatigue. Blood tests – a glucose screening test and a glucose tolerance test – are used to diagnose.

WHAT YOU CAN DO Exercise and the right diet can go a long way in controlling gestational diabetes. See a dietician or a diabetes specialist. At home, blood glucose levels can be monitored via the simple finger-prick method. You may need insulin injections. Expect extra scans to check on baby’s growth – if he grows too big you may need to deliver a week or two early.

2. PLACENTA PRAEVIA

WHAT IS IT? A low-lying placenta, bordering on, partially or completely covering the cervix – i.e. your baby’s exit route. According to the UK’s National Health Service, praevias affect about one to two percent of hospital births.

WHO’S AT RISK? Those who’ve had uterine surgery, including dilation and curettage (D & C) and caesareans, which leaves scarring on the uterine wall, older moms, smokers, those carrying more than one baby, those who’ve had placenta praevia before.

THE DANGERS Baby’s growth may be restricted, he may be delivered prematurely. If the placenta is blocking the cervix, mom will need a caesarean. If there’s severe bleeding, she may need an emergency caesarean. Placenta praevia carries a higher risk of life-threatening post-partum bleeding – a blood transfusion may be required.

SYMPTOMS Painless, recurrent vaginal bleeding in mid to late pregnancy, premature contractions, baby lying the wrong way (unable to “drop” into the pelvis). An ultrasound can pick up placenta praevia.

WHAT YOU CAN DO The placenta usually moves up the uterus during pregnancy, so a praevia is often not considered a problem early on. Later, action is required. Doctors generally recommend lots of bed rest, often in hospital, to stop mom from over-exerting herself and baby coming too early. If heavy bleeding starts before 34 weeks, steroid injections may be given to speed up baby’s lung development.

3. WEAK CERVIX

WHAT IS IT? Also known as cervical incompetence, a weak cervix shortens and opens prematurely under pressure as baby grows heavier. According to the American Pregnancy Association, a weak cervix happens in one to two percent of pregnancies and is responsible for about a quarter of second trimester miscarriages.

WHO’S AT RISK? Those who have had experiences with late miscarriages, late terminations or cervical surgery, women exposed to DES (diethylstilboestrol - a synthetic oestrogen given to pregnant mothers from 1940 to 1970) in the womb.

THE DANGERS A shortened cervix increases the chances of miscarriage or having a premature birth.

SYMPTOMS An ultrasound can measure the length of your cervix, but this is not foolproof. Sometimes sadly, the first symptom may actually be the miscarriage itself.

WHAT YOU CAN DO Your doctor may insert a cervical suture – this is a stitch – at 12 to 16 weeks to help strengthen the cervix and prevent a possible miscarriage. The stitch is then removed at around 37 weeks. This procedure – which carries its own risks – may require an operation or may be performed through the vagina under local anaesthetic. Afterwards, you may need to avoid sex and strenuous exercise.

4. PRE-ECLAMPSIA

WHAT IS IT? A life-threatening disorder occurring only in pregnancy and characterised by high blood pressure. It occurs in about five to eight percent of pregnancies, according to the American-based Pre-eclampsia Foundation.

WHO’S AT RISK? Moms over 40 or under 18; those carrying multiples; with pre-existing high blood pressure, obesity or diabetes or kidney disorder. Some research has linked it to poor nutrition.

THE DANGERS “Pre-eclampsia can cause your blood pressure to rise and put you at risk of stroke or impaired kidney function, impaired liver function, blood clotting problems, pulmonary oedema (fluid on the lungs), seizures and, in severe forms or left untreated, maternal and infant death,” says the Pre-eclampsia Foundation. It can affect blood flow to the placenta, restricting baby’s food supply, so frequent scans are needed to check on baby’s growth. If the health of mom or foetus is threatened, baby may have to be delivered prematurely. Pre-eclampsia can lead to eclampsia, which may cause convulsions, coma and death.

SYMPTOMS High blood pressure, protein in urine and severe swelling of the hands, face or ankles. Some may have headaches, blurred vision, see flashing lights, experience sudden weight gain or suffer abdominal pain or nausea. It’s typically diagnosed after week 20.

WHAT YOU CAN DO The only cure is delivery, but to ensure baby’s survival, this can’t happen too soon. In addition to changing your diet, exercising and reducing stress, you may have to take medication to lower blood pressure. Bed rest may be prescribed. Baby’s condition will be monitored. Eat a healthy diet and report any severe swelling immediately.

5. TRIPLETS

WHAT IS IT? Triplets were once rare, but not any more. Between 2002 and 2006, triplets accounted for 2.7 per 10 000 pregnancies, according to a Norwegian study published in the BJOG International Journal of Obstetrics and Gynaecology. Researchers found that the rate of triplet pregnancies to be almost two-and-a-half times higher than it was in the 1970s. This is because of the rise in both fertility drugs and number of older moms, who are more likely to have multiples.

WHO’S AT RISK? Over 30s and anyone who gone through fertility treatment. With in vitro fertilisation (IVF), more than one fertilised egg is inserted into the woman’s uterus to increase the chance of one implanting and developing. Some fertility drugs cause women to produce more than one egg at a time.

THE DANGERS Moms have a higher risk of pre-eclampsia, gestational diabetes and post-partum haemorrhage. Multiples competing for nutrients in a crowded uterus are more prone to poor foetal growth than singletons. Babies are likely to be born prematurely and often start life in the NICU. Women carrying triplets tend to deliver around 32-34 weeks, with the average birth weight at 1.8kgs. Caesareans are recommended.

SYMPTOMS Excessive morning sickness or above-average weight gain, but only an ultrasound can confirm.

WHAT YOU CAN DO
A healthy, balanced diet is vital. Do pelvic floor exercises. See an obstetrician who specialises in multiple births. Lie down, rest, put your feet up to increase blood flow to the placenta. Bed rest may also delay the onset of labour.

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