High-risk Pregnancy

A high-risk pregnancy is – according to the definition based on the maternity guidelines – a pregnancy in which either anamnestic risk factors (in the patient’s previous or medical history) are present or risks are confirmed by a surveyed examination finding. Scientific studies show that a currently identified high-risk pregnancy has a particularly high probability of complications or a high-risk birth. For the expectant mother, a high-risk pregnancy primarily means that close-meshed medical care becomes necessary. The following article provides insight into the complex topic of high-risk pregnancy and addresses the risks, examination methods, and patient care.

The procedure

The medical history (taking of the medical history) is the basis of the doctor-patient relationship. This allows your doctor to identify your personal pregnancy risks so that targeted preventive measures (= individual prenatal care) can be carried out. According to maternity guidelines, the anamnestic risks (in the patient’s medical history), which by definition mean a high-risk pregnancy, are defined as follows:

  • Severe general illness of the mother – e.g., diseases of the kidney and liver or severe obesity (adiposity).
  • Age – first birth under 18 years or over 35 years.
  • Gynecological or obstetric factors:
    • Condition after infertility treatment
    • Repeated abortions (miscarriages) or premature births
    • Previously stillborn or damaged children
    • Previous delivery of children weighing more than 4,000 g (macrosomia) or hypotrophic (underdeveloped) children
    • Previous multiple pregnancies or births.
    • Condition after uterine surgery – for example, after surgery for a myoma (benign tumor of the uterine muscles) or uterine malformation.
    • Complications of previous deliveries – e.g., placenta praevia (abnormal position of the placenta in the lower part of the uterus), premature detachment of the placenta, postpartum hemorrhage, clotting disorders, convulsions, or thromboembolism (shedding of a blood clot that clogs a vessel in the bloodstream, causing a circulatory disorder with tissue death)
    • Multi-parturient over 40 years
    • Multiparous women with more than 4 children – here there are, for example, risks such as placental insufficiency (the placenta is not able to adequately supply the unborn child with oxygen and nutrients) or obstetric mechanical complication due to overuse of the maternal body

According to maternity guidelines, the risks in the current pregnancy, which are determined by examination and by definition mean a high-risk pregnancy are defined as follows:

  • EPH-gestosis (E = edema; P = proteinuria; H = hypertension) – umbrella term for a number of conditions manifested by a range of different symptoms and occurring only during pregnancy. Depending on the time of appearance of the first symptoms, a distinction is made between early and late gestoses. Early gestoses include: emesis gravidarum (morning sickness in its moderate manifestation) and hyperemesis gravidarum (morning sickness in its extreme manifestation). The late gestoses include: pre-eclampsia and the more severe forms of eclampsia and HELLP syndrome (H = hemolysis (dissolution of erythrocytes (red blood cells) in the blood), EL = elevated liver enzymes (elevation of liver enzymes), LP = low platelets (thrombocytopenia) as well as the so-called graft gestosis (e.g. due to previous diseases). The late gestoses are sometimes called EPH gestoses according to their main symptoms. However, this designation is nowadays controversial, since, for example, edema is also common in healthy pregnant women.
  • Anemia (anemia)
  • Diabetes mellitus (diabetes) or gestational diabetes (GDM) – a special form of diabetes mellitus, which occurs for the first time during pregnancy. According to the WHO classification, gestational diabetes is also known as type 4 diabetes. GDM occurs in up to five percent of pregnant women.
  • Blood group incompatibility (incompatibility of blood groups) – AB0 incompatibility, rhesus incompatibility (incompatibility of the rhesus factor of mother and child).
  • Gynecological factors:
    • Uterine bleeding (bleeding from the uterus).
    • Disproportion between uterine size and size of the baby – e.g., questionable term,
    • Retarded (decreased, underdeveloped) growth, giant child (see above macrosomia), twins, mole formation (dead embryo or malformation of the villous tuft of the placenta), hydramnion (increased amount of amniotic fluid), or a uterine myoma (benign uterine tumor)
    • Threat of premature birth – for example, in premature labor.
    • Multiple pregnancies
    • Incorrect position of the child in the uterus
    • Ambiguity or exceeding the date of birth.

A high-risk pregnancy requires intensive prenatal care, i.e. obstetric examinations including ultrasound examinations / sonography take place more frequently: Until the 32nd week of pregnancy, regular examinations, at shorter intervals than the usual four-weekly scheduled appointments. In the last eight weeks of pregnancy, a weekly examination is often necessary. In exceptional cases, the pregnant woman is also referred to a suitable hospital for inpatient monitoring during this phase. In this case, it must be ensured that perinatological care is provided, if necessary by perinatologists (additional qualification in medicine for expectant mothers and newborns). In addition to the usual preventive examinations, a number of advanced diagnostic measures are available for use in the event of a high-risk pregnancy:

Benefits

A high-risk pregnancy is a physical and psychological burden for every expectant mother. However, with today’s comprehensive medical knowledge, innovative examinations, and preventive care options, it is possible to safely guide these patients through their pregnancies.