Better Health 2015 > Better health issue.31 : Women's Health > High-risk pregnancy Special care required

High-Risk Pregnancy Special Care Required

High-risk pregnancy

Generally, pregnancy is not a condition that needs special care. But in a high-risk pregnancy there are dangers for both the mother and the unborn infant, even to a fatal degree. What causes high-risk pregnancy? Can it be prevented? And what are treatments for it? Better Health answers these questions and highlights the latest care options.

Factors of high-risk pregnancy condition:

Dr. Rasik Rangsiprakarn, a maternal-fetal medicine specialist, explains that both the mother’s physical condition and the fetus’s development can engender a high-risk pregnancy condition. Risk factors prior to and during pregnancy impact the likelihood of high-risk pregnancy. A mother’s pre-pregnancy risk factors include:

  • Age: mothers below 18 and above 35 years of age;
  • Lifestyle: smoking, drinking or drug use;
  • Medical history: underlying diseases, such as diabetes, hypertension, kidney diseases, and thalassemia.

“In multigravida cases (where a mother has been pregnant more than once), previous pregnancies can complicate future ones. Mothers who have had more than four deliveries, three cesarean sections, an infant that weighed more than four kilograms at birth, or a mother who has had miscarriages indicate additional risk,” Dr. Rasik says.

Risk factors during pregnancy include twin pregnancy, infection, preeclampsia, gestational diabetes, placenta previa, and polyhydramnios or oligohydramnios. Unborn infant risk factors include irregular positions in the womb and certain disorders such as cleft lip, cleft palate, heart defect and missing organs. These problems can trigger preterm labor.

Preeclampsia, not frequently found but dangerous

Preeclampsia (also known as toxemia), a complication during pregnancy, raises the mother’s blood pressure to unsafe levels. Five percent of expectant mothers suffer from this severe condition that can be fatal to mother and infant.

Its cause is unknown, but may be related to abnormalities in the placenta. Preeclampsia symptoms include high blood pressure, headache, choking or chest tightness, and kidney-related edema. Severe symptoms can cause convulsions. To diagnose, urinalysis will detect suspect proteins or albumin. “In severe preeclampsia situations that threaten the mother’s life, the doctor may consider a termination of pregnancy,” says Dr. Rasik. “But if treatment can manage the condition, we will wait to the last minute, when the infant is likely to survive while also keeping the mother safe. We collaborate with neonatologists to assess the unborn infant’s health before making any decision.”

What is the scope of high-risk pregnancy?

In prenatal care, if the doctor suspects a high-risk pregnancy he takes the mother’s medical history and thoroughly examines her. If symptoms indicate, the doctor conducts further diagnosis on a case-by-case basis. For instance, in preterm birth an ultrasound scan is used to diagnose cervical insufficiency. A normal cervix is 3.5 centimeters in length. If the scan reveals the cervix is less than 2.5 centimeters there’s a risk of preterm birth.

“Along with medicines and progesterone hormone treatment to reduce contractions, new cervical cerclage technology suppresses preterm labor. In this surgical procedure the cervix is sewn closed during pregnancy until delivery; it can be performed during the gestational age of more than 16 to 18 weeks.” For a pregnant mother with a chance of toxemia, the doctor may also use ultrasound to evaluate blood flow of the uterine artery, along with an examination for a marker of the toxemia condition.

Unborn infant evaluation

unborn infant risk factors

Ironically, in high-risk pregnancy, the unborn infant itself is a risk factor. The doctor evaluates the gestating baby with these methods:


“Each pregnancy is potentially risky. Before pregnancy the mother- to-be should have a full checkup.”
Dr. Rasik Rangsiprakarn


  • An ultrasound scan looks for developmental warning signs such as the infant’s neck thickness and tissue formation such as the nasal bone. Test effectiveness depends on the examining doctor’s expertise in spotting abnormalities. The result is confirmed with a blood test and additional checking methods.
  • Amniocentesis detects Down syndrome chromosome aberrations and other genetic disorders. It is 100 percent effective. However, because amniocentesis requires insertion of a very small needle through the mother’s abdominal wall into the amniotic sac, many women today prefer less invasive methods.
  • Infant DNA via mother’s blood test (such as NIFTY and Panorama prenatal tests) that examines a particular pair of chromosomes for abnormalities. However, it cannot indicate other abnormalities.


Treating high-risk pregnancy

“Each pregnancy is potentially risky. Before pregnancy the mother-to-be should have a full checkup. Upon pregnancy, she must receive doctor-supervised prenatal care immediately and throughout gestation to reduce the chance of high-risk pregnancy.” Dr. Rasik emphasizes that high-risk pregnancy can develop at any time during pregnancy. However, proper medical care for mother and fetus can control the condition to prevent health problems. The mother must adjust her lifestyle to stay healthy, eat according to the best maternal nutrition guidelines and ensure she gets sufficient sleep and rest.

“If the mother has these unexpected symptoms – severe stomachache, headache, chest tightness, choking, ensiform cartilage pain – she must see a doctor immediately especially as the labor term approaches,” concludes Dr. Rasik.

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