A high-risk pregnancy is defined as one in which the mother and/or the fetus are at greater risk of complications, compared to pregnancies that develop normally. This may be due to aggravating factors or conditions that exist before or appear during the pregnancy.
Pre-pregnancy factors
- Mother’s age: Younger than 17 years or older than 40 years.
- Mother’s body weight: Underweight or overweight bordering on obesity.
- Several previous pregnancies
- Complicated obstetrical history: Recurrent miscarriages or abortions, early or preterm labor, previous intrauterine fetal death or neonatal death.
- Serious diseases: Heart disease (congenital or acquired), Diabetes, Arterial Hypertension, Epilepsy, Anemias and especially Type 2 Anemia, Mediterranean Anemia
-Autoimmune diseases, such as Systemic Lupus Erythematosus, Rheumatoid Arthritis and Antiphospholipid Syndrome,
-Disorders of blood coagulation such as thrombophilia, thrombocytopenia, von Willebrand disease,
-Thyroid diseases such as Graves’ disease or Hashimoto’s thyroiditis. Respiratory diseases, such as bronchial asthma, cystic fibrosis, sarcoidosis.
- Chronic inflammations: Idiopathic inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis. Endometritis, Pelvic inflammatory disease, Recurrent urinary tract infections.
- Surgical history: Previous cesarean sections, fibroid removal, enterectomy, colectomy as well as procedures involving the cervix, such as cervical conoid excision.
- Functional and anatomical anomalies of the uterus: Unicorn or Bicorn uterus, Fibroid uterus, “Excessively” small uterus, Uterine septum, Endometrial adhesions (Asherman’s syndrome).
All the aforementioned diseases may relapse due to pregnancy or complicate the course of an otherwise normal pregnancy. It is therefore vital for women who present any of the above problems to have carried out all the necessary exams and receive the corresponding treatment before starting their pregnancy journey .
Factors that occur during pregnancy
- Multiple pregnancies
- Placental abruption (peripheral or central).
- Placenta previa: It is the placenta that implants and develops in the lower part of the uterus and when it finally covers the entire internal surface of the cervical canal, it is characterized as placenta previa. This may lead to bleeding, especially if myometrial activity is present.
- Premature delivery: It is the delivery that takes place before the 36th – 37th week of pregnancy and may be due to various infections, cervical insufficiency, early or premature rupture of membranes or when there is already a history of early or premature delivery.
- Intrauterine fetal growth retardation: Refers to those fetuses whose body weight is lower than expected, for the corresponding week of pregnancy. Possible causes can be reduced nutrient & poor food intake by the mother, toxic substances such as alcohol and smoking, as well as reduced blood flow to the placenta.
- Disorders related to amniotic fluid: Oligoamnios or Hydramnios.
- Chromosomal abnormalities.
- Liver diseases: Hyperemesis, Intrahepatic cholestasis, Acute viral hepatitis, Fatty liver, Cholelithiasis, Preeclampsia/Eclampsia/HELLP syndrome.
- Hypertensive disease of pregnancy: Hypertension that turns up for the first time after the 20th week of pregnancy and usually disappears after delivery and within 6-12 weeks.
- Pre-eclampsia: Pre-eclampsia is a multisystemic disease that usually occurs in the second half of pregnancy and is manifested by the main symptoms of hypertension, albuminuria and edema. There are also cases in which severe headache, abdominal pain, blurred vision and/or abnormal laboratory findings from the liver and platelet count may coexist. Eclampsia develops into severe pre-eclampsia and is characterized by convulsions.
- Gestational Diabetes: Pregnancy is a diabetogenic factor and this is due to the hormonal changes that occur, the main of which is the increased production of insulin. Therefore, while at the beginning of pregnancy the daily insulin needs are usually adequately met, from the 26th week onwards they increase, resulting in the disturbance of carbohydrate metabolism and the creation of Gestational Diabetes.
Clearly, there is also that category of women who have already, before reaching pregnancy, been diagnosed with metabolic disorders, such as insulin resistance.In these cases, increased supervision by an endocrinologist in collaboration with the treating gynecologist, already from the beginning of pregnancy, is a necessity. First of all, of course, the understanding of the problem by the patient herself and her absolute compliance with the instructions of the treating doctors is necessary.
The diagnosis of diabetes is made mainly by a glucose tolerance test and/or by periodic measurement of blood sugar levels. Diabetes can be eliminated with proper diet, which is recommended to be designed by a specially trained dietitian, exercise, if this is permissible and by the administration of insulin.
Dionysia Bikou, Midwife
