Risky Pregnancy (Perinatology) and High Risk Pregnancy: Risk Factors, Complications and Treatment

Pregnancy; It is a period when maternal and fetal health should be closely monitored.

Pregnancy; It is a period when maternal and fetal health should be closely monitored. During this period, some changes occur in the mother’s body to ensure optimal development and growth of the fetus. Pre-existing diseases in the mother or new conditions that occur during this change can cause serious complications during pregnancy. The higher probability of these complications arising from the mother or the fetus means that the pregnancy is high risk. Perinatology is a field that deals with risky pregnancies.

What is Risky and High Risk Pregnancy?

Risky pregnancy occurs when the person giving birth develops various health problems both before and during pregnancy. Chromosomal disorders and structural anomalies in the fetus also cause pregnancy to be considered risky. Perinatology, also known as maternal fetal medicine; It is the field of gynecology and obstetrics where pregnant women with risk factors for high-risk pregnancy are closely monitored and detailed tests are performed to evaluate maternal and fetal health. Gynecologists and obstetricians who specialize in perinatology provide services in the management of high-risk pregnancies.

What Causes Risky and High-Risk Pregnancy?

Risky pregnancy; It may occur due to health problems with the mother, the fetus, or both. Situations that may cause high-risk pregnancy are as follows:

• Health problems that existed before pregnancy
• Pregnancy-related disorders
• Risky lifestyles such as tobacco, alcohol and drug use
• Being over 35 and under 17

Maternal diseases before pregnancy may increase the likelihood of developing complications during pregnancy. The most common of these diseases are:

• Autoimmune diseases such as Lupus and MS
• Diabetes
• Hypertension
• kidney disease
• AIDS
• COVID-19
• Extreme underweight (Body Mass Index less than 18.5)
• Obesity
• Mental disorders such as depression
• thyroid diseases
• Polycystic Ovary Syndrome (PCOS)
• blood clotting disorders
• Structural disorders in the uterus such as fibroids

As with diseases existing before pregnancy, some conditions that develop during pregnancy may also increase the risk of complications. Some of these conditions that develop during pregnancy are as follows:

• Structural defect or genetic disease in the fetus
• Developmental delay in the fetus
• gestational diabetes
• Multiple pregnancy
• Eclampsia or preeclampsia
• Complications from previous pregnancies, such as premature birth

What are the Signs and Symptoms of Risky and High-Risk Pregnancy?

In high-risk pregnancies, some symptoms may occur in the mother. These symptoms may develop against the background of a serious condition that can be life-threatening. Therefore, pregnant women who show one or more of the following symptoms should consult a doctor without delay:

• Persistent abdominal pain
• chest pain
• Dizziness, fainting
• Overstrain
• Baby movements slow down or stop
• fever over 38 degrees
• heart palpitations
• Extreme nausea, vomiting
• Headache that does not go away or gets worse
• Swelling, redness, pain in the face and limbs
• Presence of thoughts such as harming the mother herself or the fetus
• Shortness of breath
• vaginal bleeding

At What Age Is Pregnancy Considered High Risk?

The age factor carries a risk in older pregnancies. Pregnancy is considered risky if the maternal age is over 35 or under 17.

Pregnant women over the age of 35 are more likely to have complications such as gestational diabetes and preeclampsia. Problems such as anemia, sexually transmitted diseases and premature birth are more common in pregnant women under the age of 17. Expectant mothers under the age of 17 are more likely to have inadequate prenatal and postnatal follow-up and care. This is one reason why pregnancy is risky.

What are the Possible Complications of High-Risk Pregnancy?

A high-risk pregnancy can lead to life-threatening complications. Complications that may occur due to high-risk pregnancy are as follows:

• Preeclampsia: Preeclampsia is a condition characterized by high blood pressure of the mother during pregnancy. In pregnancies with preeclampsia, problems such as fetal development delay, premature birth, and placenta malposition may occur. Pregnant women with preeclampsia need to be closely monitored.

• Eclampsia: Eclampsia describes the condition that occurs as a result of a seizure in a pregnant woman diagnosed with preeclampsia. Eclampsia can seriously threaten the health of both mother and baby. Therefore, it should be treated immediately and the pregnant woman should be closely monitored.

• Premature Birth: Preterm, or premature birth, is the occurrence of labor before the 37th week of pregnancy. Babies born prematurely are more likely to experience problems such as respiratory distress and developmental delay.

• Caesarean Birth: Caesarean section is a form of birth in which the uterus is reached through an incision on the mother’s abdomen and the baby is removed by making an incision in the uterus. Cesarean birth is a riskier procedure than normal vaginal birth in terms of the risk of complications.

• Excessive Bleeding at Birth: It is normal to have a certain amount of bleeding during birth. However, in high-risk pregnancies, the amount of bleeding during and after birth may be excessive. This situation can progress to a level that threatens the mother’s life.

• Low or High Birth Weight: The weight of term babies, whose weight is below 2500 grams, indicates low birth weight, and its weight above 4000 grams indicates high birth weight. Both situations have their own risks.

• Structural Anomalies: In high-risk pregnancies, the risk of developing structural anomalies in the fetus is high. Conversely, a structural defect in the fetus causes the pregnancy to fall into the risky category.

• Miscarriage and Stillbirth: In risky pregnancies, problems arising from both the mother and the fetus may result in miscarriage or stillbirth.

Prevention and Treatment of Pregnancy Complications

The main goal is to protect the health of mother and baby in high-risk pregnancies. For this reason, those with risky pregnancies should be followed closely by a perinatologist throughout pregnancy. The perinatologist can use these methods to monitor maternal and fetal health during this process:

• Detailed Ultrasound: Detailed ultrasound allows the fetus in the womb to be evaluated for possible structural disorders. By detecting the structural anomaly at an early stage, this disorder can be corrected or the anomaly can not progress further.

• Blood and Urine Analysis: Conditions that may cause a risky pregnancy in the mother, such as preeclampsia, diabetes, and thyroid diseases, can be detected by blood and urine analysis.

• Genetic Test: When a possible genetic syndrome in the fetus is suspected, genetic screening can be performed with samples taken from both the fetus and the parents.

• NST: NST, which shows the fetal heartbeat and contractions in the uterus, is a method used in pregnancies that do not pose any risk. In high-risk pregnancies, the NST method is used in the earlier weeks and this test is performed more frequently.

Treatment of risky pregnancies is done according to the reason that makes the pregnancy risky. For example, the blood sugar of a diabetic mother must be kept under control throughout pregnancy. In high-risk pregnancies due to structural anomaly in the fetus, the fetus is followed closely until birth. After birth, a surgical intervention is planned to correct the relevant structural anomaly and the baby is ensured to stay in a health center with neonatal intensive care facilities.

To prevent complications related to risky pregnancy, parents with risk factors should consult a gynecologist before birth and receive genetic counseling when necessary. Planning your pregnancy reduces the chances of experiencing health problems during pregnancy.

Today, a significant portion of pregnancies are in the high-risk pregnancy category. However, with close follow-up and treatment, it is possible to avoid serious complications related to risky pregnancy. It would be beneficial for women who are planning to become pregnant or who are already pregnant to apply to a well-equipped hospital and, if necessary, to go to a perinatologist.