During Pregnancy Besides the emotional condition of the mother that needs attention, “high-risk pregnancy” is another dangerous condition that may adversely affect both the mother and the fetus. This article is something that both mothers and close ones should know to pay attention and observe signs of abnormalities… before it’s too late.
Risk Factors for Pregnancy
- History of previous pregnancies
- Fetal death during pregnancy, labor, or after birth
- History of miscarriage
- History of preterm birth (gestational age before 37 weeks)
- History of delivering babies with low birth weight (less than 2500 grams) or high birth weight (more than 4000 grams)
- History of pregnancy with preeclampsia
- Maternal factors
- Chronic diseases such as heart disease, diabetes, hypertension, hyperthyroidism, anemia, epilepsy, tuberculosis, AIDS, syphilis, hepatitis B virus, rubella
- Maternal body characteristics such as small stature, narrow pelvis, short height not exceeding 140 centimeters
- Age younger than 15 years or older than 35 years
- Abnormalities during pregnancy such as twin pregnancy, abnormal fetal presentation, uterine fibroids, hypertension, diabetes, anemia, urinary tract infection
How to Assess High-Risk Pregnancy
When a mother becomes pregnant, she should register for antenatal care immediately upon confirmation to ensure both mother and baby receive care throughout the pregnancy. This includes receiving advice from doctors and nurses on self-care and fetal care, as well as risk assessment of the pregnancy to plan treatment and manage complications during pregnancy and labor to help prevent harm to both mother and baby. During antenatal care, doctors will assess high-risk pregnancy as follows:
- Taking medical history, asking about the first day of the last menstrual period to calculate gestational age and estimate delivery date, inquiring about chronic diseases, previous pregnancy history, drug allergies, and food allergies
- General physical examination to check for anemia, jaundice, and swelling
- Blood tests to check blood type, syphilis, AIDS, hepatitis B virus, and anemia
- Urine tests to check for sugar and protein
- Blood pressure measurement
- Examination of the uterine fundus to assess fetal size
- Ultrasound examination to detect fetal abnormalities, amniotic fluid, and placenta
- Weighing to assess fetal growth
- Measuring height to assess risk of delivery, especially for small, short mothers with narrow pelvis who may have difficult labor
Dangers from Complications During Pregnancy
Severe complications during pregnancy affect the health of both mother and fetus and increase the risk of death. Therefore, attention should be given to monitoring, planning prevention, and proper management to ensure the safety of mother and baby. Important complications include:
Preeclampsia
This condition occurs when a pregnant mother has high blood pressure (greater than or equal to 140/90 mmHg) along with protein in the urine, causing swelling of the face, hands, legs, and feet; some experience headaches, blurred vision, and epigastric discomfort. If untreated properly, it may cause seizures, cerebral hemorrhage, and can be fatal. It also increases the risk of preterm birth and low birth weight babies.
Cause: Unknown, but often found in mothers older than 35 years or younger than 20 years, twin pregnancies, and mothers with chronic diseases such as kidney disease, diabetes, and hypertension.
Treatment: Doctors provide blood pressure control medication, anticonvulsants, terminate pregnancy at the appropriate time, and monitor blood pressure and urine regularly.
Molar Pregnancy
This is an abnormality during fertilization where there is no embryo but many small cysts resembling fish eggs inside a sac. It occurs because the female egg lacks sex chromosomes, causing vaginal bleeding, hemorrhage, and possibly shock and unconsciousness.
Cause: Unknown, but risk factors include older pregnant women, smokers, and first pregnancies.
Treatment: Termination of pregnancy by suction or curettage of the uterus.
Placenta Previa
This condition occurs when the placenta attaches abnormally, partially covering the cervix. Normally, the placenta attaches to the upper part of the uterus, causing bleeding and vaginal hemorrhage.
Risk factors: Maternal age over 35 years, history of uterine curettage, uterine fibroid surgery, twin pregnancy, abnormal fetal presentation.
Treatment: If bleeding is minimal, rest, avoid heavy work, take iron supplements, and possibly perform cesarean section before full term.
Gestational Diabetes
This condition occurs when a pregnant mother has higher than normal blood sugar without previous diabetes. Hormones from the placenta counteract insulin, preventing normal sugar utilization, resulting in large, overweight babies, difficult labor, risk of preterm birth, reduced blood flow to the uterus, small babies, and possible fetal death.
Risk factors: Overweight before pregnancy, pre-existing diabetes, history of delivering babies over 4 kilograms, hypertension, family history of diabetes.
Treatment: Dietary control, insulin administration, and blood sugar monitoring.
Threatened Abortion
This condition involves bleeding from the uterine cavity during pregnancy caused by various factors such as congenital fetal defects, chromosomal abnormalities, hormonal disorders, smoking, and maternal chronic diseases like hypertension. Symptoms include spotting vaginal bleeding and lower abdominal pain.
Treatment: Doctors perform ultrasound and pregnancy hormone (HCG) tests. If the embryo is dead, hormone levels drop, and the pregnancy ends in miscarriage. If the embryo is alive, close monitoring is required. Doctors may prescribe hormones to prevent miscarriage, recommend bed rest, abstain from sexual intercourse, avoid heavy activities, and avoid activities that strain the abdomen.
Abnormal Symptoms During Pregnancy That Require Medical Attention
- Epigastric discomfort, bloating, abdominal pain
- Vaginal bleeding
- Frequent headaches, blurred vision
- Swelling of the face, hands, legs, and feet
- Excessive or insufficient weight gain
- No fetal movement or decreased fetal movement after 20 weeks of gestation
Prevention of High-Risk Pregnancy
Prevention of high-risk pregnancy can begin before conception by planning for pregnancy through consultation with an obstetrician-gynecologist for general physical examination, chronic diseases, genetic diseases, vaccination before pregnancy such as rubella, and weight control before pregnancy to prevent high-risk pregnancy.
Pregnancy Care to Prevent High-Risk Pregnancy
- Register for antenatal care immediately upon confirmation of pregnancy, inform doctors of your chronic diseases and family medical history for risk assessment and receive proper advice throughout pregnancy from doctors and nurses
- Avoid smoking, coffee, alcohol, and drug use
- Avoid activities that may affect pregnancy
- If having chronic diseases such as diabetes or hypertension, control the disease within normal limits
- Exercise regularly; pregnant women should consult their doctor individually
- Get enough rest and reduce stress
- Take medications as prescribed by the doctor; consult the doctor before taking any other medications
- Attend all medical appointments and if abnormal symptoms occur such as vaginal bleeding, abdominal pain, headache, blurred vision, or decreased fetal movement, see a doctor immediately without waiting for the scheduled appointment
High-risk pregnancy is a warning sign for parents to increase awareness and prepare to handle the situation to ensure the safety and good health of both mother and baby.
Dr. Tharinee Lamluk
Specialist in Maternal-Fetal Medicine
Women’s Health Center, Phyathai 2 Hospital
