High-Risk Pregnancies

Prof. Dr. Derya Eroğlu

Gynecology and Obstetrics and Perinatology Specialist

Today, many pregnancies are completed without any problems and the mother is happy to hold her baby in her arms. However, there are some risky situations that threaten the health of both the baby and the mother, and even cause their death. While some of these conditions that pose a risk to pregnancy may be known problems before pregnancy, some of them may occur as the pregnancy progresses. The branch of science dealing with the problems of these high-risk pregnancies is called maternal fetal medicine or perinatology, and obstetricians working in this field are called perinatologists. The aim of perinatology is to determine the conditions that pose risks for the health of the mother and the baby in a timely manner and to help the pregnancy to be as healthy and unproblematic as possible.

Risky pregnancy, morbidity in the mother, fetus or newborn before or after birth (illness) and/or mortality (death) risk is higher than the general pregnant population (states defined as high risk).

What are the High Risk Conditions for Mother and/or Baby?

• Additional internal problem before pregnancy (diabetes, thyroid disease, high blood pressure etc.)

• Drug or alcohol use during pregnancy, exposure to radiation

• Multiple pregnancies

• Hereditary disease in the family

• Advanced maternal age

• History of giving birth to a baby with congenital anomaly (handicapped)

• Detection of growth retardation in the baby

• History of premature birth

• Recurrent miscarriages

• History of preeclampsia/eclampsia (pregnancy poisoning) in a previous pregnancy

• Situations where the risk of carrying a baby with a chromosomal abnormality is high

• High risk in Down syndrome screening tests

• History of giving birth to a baby with chromosomal abnormality

Why is Fetal Ultrasonographic Examination Important?

The importance of ultrasonographic examinations during pregnancy in the follow-up of babies is increasing. r. 18-22 weeks of pregnancy. With the detailed fetal ultrasonographic examination performed in the 20th week, the external and internal anatomy of the baby is evaluated and a significant part of the severe structural anomalies at birth can be detected. In addition, ultrasound markers associated with chromosomal abnormalities can be detected, and pregnant women with high risk in this regard can be identified. 11-13 of pregnancy. The nuchal translucency measurement and the double combined test performed at the 2nd week of pregnancy may predetermine the possible risk for chromosomal anomalies, some syndromes, congenital heart diseases and some problems in twin pregnancies. Ultrasonographic evaluation should be done in centers with advanced ultrasonography devices and by experts trained in this field.

Growth retardation may occur in approximately 6-8% of fetuses during pregnancy. Color Doppler ultrasonography, which evaluates the placenta and the baby's blood flow, also gives important information about the baby's condition. Therefore, ultrasonography should be included in prenatal follow-up.

Which Procedures Can Be Used for Diagnosis?

In some cases, chorionic villus sampling (sampling from the placenta), amniocentesis (in the sac the baby is in) to diagnose high-risk pregnants Amniotic fluid sampling) or cordocentesis (taking blood from the baby's cord) may be required.

Common problems

DRUG USE

• Using certain drugs during pregnancy It may have a negative effect on the developing tissues and organs of the baby.

• The most important of these drugs are antiepileptics (drugs used in the treatment of epilepsy), some of the drugs used for high blood pressure, acne (acne) treatment Some of the drugs used are alcohol, some antidepressants, some anticancer drugs and addictive substances.

• Mothers who used these substances in the early stages of pregnancy should be aware that some congenital anomalies may be seen in their babies.

• With detailed fetal ultrasonographic examination to be performed during pregnancy, it is possible to detect possible anomalies that may occur in the baby before birth.

GESTATIONAL (Pregnancy-Related) DIABETES

• It is glucose intolerance of various degrees that begins during pregnancy or is diagnosed for the first time during pregnancy. It may or may not return to normal after pregnancy.

• It is seen in 5-6% of pregnancies.

• The risks in the baby are macrosomia (large baby) ), shoulder fixation at birth (birth trauma), respiratory distress in newborns, low newborn blood sugar, decrease in newborn calcium level, jaundice, childhood diabetes, obesity, increased amniotic fluid and premature birth, death in the womb (in pregnant women whose blood sugar cannot be regulated by diet).

• Maternal risks include miscarriage, preeclampsia (pregnancy poisoning), infections, difficult delivery, operative delivery (vacuum or cesarean delivery), postpartum hemorrhage and recurrence in subsequent pregnancies (66%). ). The long-term risks are obvious diabetes and metabolic syndrome.

• Diet (diabetic diet), exercise and, if necessary, insulin therapy should be recommended.

OVERPENTAL DIABETES

• The probability of a good pregnancy outcome is related to the mother's blood sugar control, but the most important thing is to have any underlying cardiovascular and kidney disease. is the degree.

• Increased risk of miscarriage of the effects of overt diabetes in the baby, premature birth, congenital malformations (handicaps), infant death in the womb, polyhydramnios (increased amniotic fluid), newborn respiratory distress, newborn blood sugar and decrease in calcium level, increase in bilirubin level in the baby's blood and jaundice, enlargement of the heart, risk of diabetes in the baby and retardation in baby growth.

• The effects of overt diabetes on the mother are diabetic kidney disease, diabetic eye disease, diabetic nerve damage, preeclampsia (pregnancy poisoning) and infections.

• Women with overt diabetes should consult an obstetrician and an endocrinologist before pregnancy. Pre-pregnancy blood sugar should be kept at an ideal level with insulin. The parameter called Hemoglobin A1 C, which gives an idea about the blood sugar levels in the last 4-8 weeks, should be at the ideal level. 400 µg/day folic acid to reduce the risk of neural tube defects It should be recommended to take it.

• 18-22. Detailed fetal ultrasonography and fetal echocardiography should be performed to detect neural tube defects, heart anomalies and other anomalies during the gestational week.

• To prevent birth traumas such as shoulder insertion related to large baby in women with overt diabetes Cesarean section should be preferred.

Preeclampsia (Pregnancy Poisoning)

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Preeclampsia is a maternal blood pressure of 140/90 mmHg and above, accompanied by protein leakage in the urine.

It is seen with a frequency of 6-8% in the general population.

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The effects of preeclampsia in the mother are cerebral hemorrhage and brain damage, pulmonary edema, kidney failure, heart failure, liver failure and death.

The effects of preeclampsia on the baby are problems due to premature birth, growth retardation and death in the womb.

The patient should be taken to bed rest in mild preeclampsia. Low-risk patients can be followed up under controlled conditions. In cases above 37 weeks of gestation, when the cervix (cervix) is suitable for delivery, when severe symptoms occur in the mother or if the baby is in bad condition, delivery should be performed under the precaution of eclampsia (preeclampsia and seizures).

In severe preeclampsia, delivery should be performed in cases above 34 weeks of gestation. Delivery should be performed in patients under 34 weeks of gestation when uncontrollable severe high blood pressure, eclampsia (preeclampsia and seizures), impaired liver and kidney function, abdominal pain, persistent headache and visual symptoms.

EARLY BIRTH

• Preterm birth, that is, preterm birth, is the birth before 37 weeks of gestation.

• Premature birth rate is 12% in singleton pregnancies, 54% in twins and 93% in triplets and others.

• Who is at risk?

1. Age younger than 17 and older than 35

Low socioeconomic status

Being underweight before pregnancy

Having a history of preterm birth in previous pregnancies

People with vaginal bleeding in early pregnancy

Smoking, insufficient maternal weight gain during pregnancy , those who use contraceptive drugs

Those with genetic predisposition

Chorioamnionitis (infection in the baby's membranes and amniotic fluid)

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Cervical insufficiency (insufficient connective tissue of the cervix)

• What should expectant mothers who are at risk of preterm birth to pay attention to ?

1. Cervical insufficiency (cervical insufficiency) should be determined before conception and cervical length (cervix length) should be measured by transvaginal ultrasonography during pregnancy. If necessary, sutures (cervical cerclage) can be placed on the cervix in these patients.

They should be at the ideal weight for their height before pregnancy; they should gain ideal weight during pregnancy.

   3. Not smoking and not using any medication without the knowledge of the physician

4. If there is a history of preterm birth, evaluation by the physician in terms of cervicovaginal infections in the early weeks of pregnancy

5. If there is a history of preterm birth, measuring the cervical length (cervical length) by transvaginal ultrasonography and starting progesterone treatment starting from the 16th gestational week

Patients who had conization (partial removal of the cervix) due to cervical cancer before Patients with congenital developmental anomalies in the uterus (womb) and uterus are particularly at risk in this regard.

MULTIPLE PREGNANCY

• There has been a significant increase in the number of multiple pregnancies with increasing in vitro fertilization practices in recent years.

• Multiple pregnancies, premature birth, congenital anomalies, and high blood pressure or diabetes that may occur in the mother It carries a high risk in terms of pregnancy complications such as disease.

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