High risk pregnancy care

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High risk pregnancy care

Your pregnancy is called high-risk if you or your baby has an increased chance of a health problem. Many things can put you at high risk. Being called “high-risk” may sound scary. But it’s just a way for doctors to make sure that you get special attention during your pregnancy. Your doctor will watch you closely during your pregnancy to find any problems early.

The conditions listed below put you and your baby at a higher risk for problems, such as slowed growth for the baby, preterm labor, preeclampsia, and problems with the placenta. But it’s important to remember that being at high risk doesn’t mean that you or your baby will have problems.

Your health plan may have its own list of what makes a pregnancy high-risk. In general, your pregnancy may be high-risk if:

      • You have a health problem, such as: Diabetes.
        • Cancer
        • High blood pressure
        • Kidney disease
        • Epilepsy
      • You use alcohol or illegal drugs, or you smoke.
      • You are younger than 17 or older than 35.
      • You are pregnant with more than one baby (multiple pregnancy).
      • You have had three or more miscarriages.
      • Your baby has been found to have a genetic condition, such as Down syndrome, or a heart, lung, or kidney problem.
      • You had a problem in a past pregnancy, such as:
        • Preterm labor
        • Preeclampsia or seizures (eclampsia)
        • Having a baby with a genetic problem, such as Down syndrome.
    • You have an infection, such as HIV or hepatitis C. Other infections that can cause a problem include cytomegalovirus (CMV), chickenpox, rubella, toxoplasmosis, and syphilis.
    • You are taking certain medicines, such as lithium, phenytoin (such as Dilantin), valproic acid (Depakene), or carbamazepine (such as Tegretol).

Other health problems can make your pregnancy high-risk. These include heart valve problems, sickle cell disease, asthma, lupus, and rheumatoid arthritis. Talk to your doctor about any health problems you have.

Symptoms

Many women who have fibroids don’t have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common symptoms of uterine fibroids include: Heavy menstrual bleeding

  • Menstrual periods lasting more than a week
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

When to see a doctor

See your doctor if you have: Pelvic pain that doesn’t go away

  • Overly heavy, prolonged or painful periods
  • Spotting or bleeding between periods
  • Difficulty emptying your bladder

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

Causes

Doctors don’t know the cause of uterine fibroids, but research and clinical experience point to these factors:

  • Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
  • Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
  • Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue.

The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Risk factors

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include:

  • Heredity. If your mother or sister had fibroids, you’re at increased risk of developing them.
  • Race. Black women are more likely to have fibroids than women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids.
  • Environmental factors. Onset of menstruation at an early age; use of birth control; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

How will your doctor care for you during your pregnancy?

You will have more visits to the doctor than a woman who does not have a high-risk pregnancy. You may have more ultrasound tests to make sure that your baby is growing well. You will have regular blood pressure checks. And your urine will be tested to look for protein (a sign of preeclampsia) and urinary tract infections.

Tests for genetic or other problems also may be done, especially if you are 35 or older or if you had a genetic problem in a past pregnancy.

Your doctor will prescribe any medicine you may need, such as for diabetes, asthma, or high blood pressure.

Talk to your doctor about where he or she would like you to give birth. Your doctor may want you to have your baby in a hospital that offers special care for women and babies who may have problems.

If your doctor thinks that your health or your baby’s health is at risk, you may need to have the baby early.

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