Avoiding a High-Risk Pregnancy

2 May 2016, BKK Kids

A child is the greatest gift for parents. However, nothing is ever certain. Parents-to-be should always take extra care throughout the entire nine months of a pregnancy because it is a very important period. Precautions taken before and during pregnancy can reduce the chance of having a high-risk pregnancy.

What is a High-Risk Pregnancy?

A high-risk pregnancy is a case where certain factors can place a pregnant woman and the fetus at risk. It can result in a death during the pregnancy, during the delivery and even after the delivery, such as in the case of a preterm birth or preeclampsia (pregnancy induced hypertension). The risk factors to look out for include underlying conditions in the mother-to-be, such as diabetes or high blood pressure; a history of preterm births, problems during delivery, miscarriages, or a myomectomy (a surgical removal of fibroids from the uterus), a multiple pregnancy, or the mother-to-be being aged 35 years and above.

Women with diabetes, thyroid disease or other underlying diseases should consult a doctor before becoming pregnant in order to manage the conditions and prevent a high-risk pregnancy. During the antenatal care sessions at the hospital, an obstetrician will ask the mother-to-be a series of questions to determine the risk factors. The level of risk in the pregnancy can also be assessed by a blood pressure test, physical examination, fundal height measurement, and laboratory tests like urinalysis.

There is always a degree of risk in any pregnancy due to the hormonal and physical changes that take place in the mother-to-be. However, based on the results of the risk assessment, the doctor will advise the mother-to-be on how best to minimize those risks during her pregnancy. While the fetus can also cause health risks, the mother-to-be and fetus can usually adjust themselves to the conditions naturally. In some cases, there may even be complications in both mother-to-be and fetus. However, the advanced technology available today enables us to prevent high-risk pregnancies.

Prevention for a Healthy Pregnancy

Advanced medical technology enables us to be more efficient than ever before in preventing high-risk pregnancies. Prevention is always better than cure. The management of some complications, however, such as preterm birth, preeclampsia and intrauterine growth restriction, is not very effective due to the unknown causes of these conditions.

It is essential that prior to conception both parents ensure that they are in good health. Women should not be overweight, and should become pregnant when they are at the right age, not too young or too old. If preparing for pregnancy, a physical examination is recommended. The tests will vary according to one’s personal health history. Without serious illnesses, genetic conditions, and family history of pregnancy disorders, one will only need to be tested for blood type and basic diseases, such as rubella, hepatitis, and thalassemia, the latter being a condition more common in Asians. Before taking a physical examination, one should provide the doctor with their family health history so that he or she can make an accurate and effective diagnosis.

A High-Risk Pregnancy… Can Be Avoided

Preeclampsia generally develops after 20 weeks, or about five months, into the pregnancy. In most cases, it occurs after 32 weeks (eight months), although it can also develop up to 48 hours after the baby is born. The most effective way of preventing preeclampsia is by giving medication in high risk cases before 16 weeks of pregnancy.

Biochemical markers and uterine artery measurements are useful for determining the risk of preeclampsia in women as well as low birth weight in babies. In the case of abnormal results, preventive medication can be given immediately. Currently, sFIT/PIGF is the reliable test used to predict preeclampsia and other conditions, as well as to measure the severity of the condition so as to be able to provide the most suitable prevention and treatment. In Thailand, there are only three hospitals with the ability to perform this test, and Bumrungrad Hospital is the only one that performs this test 24 hours a day with the test results available within just 18 minutes.

The cervical length is measured by ultrasound to determine the risk factors for a preterm birth. The progesterone hormone helps reduce the rate of early preterm births by 45% in pregnant women with a short cervix. In Thailand, Bumrungrad Hospital is also the first and only hospital that uses a vaginal ring in combination with progesterone. Fibronectin and PAMG-1 tests are used to predict preterm delivery and rupture of amniotic membranes, and can provide results within approximately 15 to 20 minutes. This fast diagnosis enables treatment to be administered early enough to reduce the length of time spent in hospital and the amount of medication required.

Also, due to recent advances in prenatal screening and diagnosis, the maternal blood test for Down’s syndrome can now be performed with 99.6% accuracy within 7 to 10 days. An amniocentesis can be used to diagnose Down’s syndrome and the results will be available within 24 to 48 hours. If an ultrasound shows fetal abnormalities, further diagnostic tests will be required to detect abnormalities at the gene levels.

Prenatal care should begin as early as possible. The doctor can check to see if the pregnancy is inside the uterus or on the outside. The prenatal tests and measurements include: fetal heartbeat, length of pregnancy, ultrasound during the 12th to 13th weeks of pregnancy to measure the thickness of the fetus’ neck and detect chromosomal abnormalities, fetal heart diseases, uterine artery measurement, cervical length measurement to predict preeclampsia and preterm birth, ultrasound during the 18th to 22nd weeks to detect fetal organ abnormalities, and ultrasound during the 28th to 32nd weeks to gauge fetal growth and manage possible problems before they develop. With a team of specialist doctors and nurses and a well-equipped laboratory, Bumrungrad Hospital is well-prepared to manage all high-risk pregnancy conditions effectively.

High-risk pregnancy can be prevented during the early stages of prenatal care. Parents-to-be should always manage the pregnancy with care so that their newborns will be in good health and get off to a great start.

By  Dr. Boonsri Chanrachakul, an obstetrician specializing in Maternal and Fetal Medicine at Bumrungrad Hospital’s Women’s Center.

Editor’s note: This article is sponsored content from Bumrungrad International Hospital, and it is reprinted here with permission of the hospital.