Having a baby is often a natural process. After a pregnancy that goes well, the woman's pain begins, the birth takes place and a healthy baby is born. Unfortunately, not all pregnancies go smoothly.
What is a High-Risk Pregnancy?
If there is a condition that will affect both the mother and the baby, it is called a high-risk pregnancy. Follow-up of high-risk pregnancies differs from normal pregnancies. Perinatologist, obstetrician, internist, endocrinologist, dietitian, pediatric surgeon, neonatal specialist and geneticist may take part in the follow-up of risky pregnant women.
Perinatologists follow the mother and baby in the prenatal and postnatal 4-week period, which we call the perinatal period, and manage the process. It is the duty of perinotologists to plan and perform tests suitable for risky pregnant women.
Even during a seemingly normal pregnancy, a problem may develop later. Therefore, regular follow-up of all pregnant women is important.
What are the Causes of High-Risk Pregnancy?
Maternal age: It is one of the most common risk factors. Complications are more common in pregnancy if the mother is younger than 17 or older than 35. Miscarriage during pregnancy and genetic defects in the baby are more common in pregnant women over the age of 40.
Diseases before pregnancy: Pre-pregnancy hypertension, lung, kidney, heart problems, diabetes, autoimmune disease, sexually transmitted diseases and AIDS If there is, it may pose a risk to the mother and baby during pregnancy. The mother's previous miscarriage, the risk of previous pregnancies, and a family history of genetic disorders are other factors that increase the risk during pregnancy.
The fact that the economic and social conditions are very bad may pose a problem in terms of nutrition, care and follow-up of the pregnant woman. Risky pregnancy is more common in this group.
What are the Problems Developing During Pregnancy?
Early separation of the placenta (the baby's partner): Generally, after the 20th week, the placenta separates spontaneously and the mother has severe bleeding or occult bleeding. As separation increases, bleeding increases and abdominal pain occurs. Some patients may experience shock. Premature separation of the placenta poses a great risk for both mother and baby. Premature detachment of the placenta in older women, those with hypertension In addition, it is more common in polyhydramnios, in cases of excess water in the baby, in the presence of infection in the birth tract, vasculitis (inflammation of small vessels), those who have had this problem before, those who have had abdominal trauma, those who smoke, premature rupture of the membranes (premature rupture of the baby's water), and those who use cocaine. consists of.
Preeclampsia: It is a disease that progresses with protein excretion in the urine and high blood pressure in pregnant women older than 20 weeks. It is more common in those who continue their first pregnancy, have diabetes, have hypertension before, if the mother's age is very young or old, if there is a family history of preeclampsia, in those who have multiple pregnancies, in those who are obese and have coagulation disorders. However, the cause is not known exactly.
Eclampsia: If seizures develop in the expectant mother after preeclampsia, eclampsia is mentioned.
Gestational diabetes: Hypertension may develop in the mother due to gestational diabetes. The baby may be very large and the need for a cesarean section may arise. Babies of diabetic mothers are born with many problems.
Urinary tract infection during pregnancy: It can cause premature birth of the baby, premature birth and respiratory distress in the baby.
In the presence of a sexually transmitted disease in the mother, it can cause death, birth, serious disability and abnormalities in the baby. It is difficult and the surgery is life-threatening for the mother and the baby.
Fetal dystocia is the abnormal size and placement of the baby. Early cesarean section may be decided as it may result in difficult delivery. Having the baby in the breech position is also a cause of difficult delivery.
Cervical insufficiency during pregnancy: The cervix is located between the uterus and the vagina. Cervical insufficiency can lead to miscarriage or premature birth. Gaining a lot of weight in the mother during pregnancy: Hypertension in the mother, diabetes, delayed baby's delivery, death of the baby in the womb and the baby being born too large.
Virus infection of the mother during pregnancy: Herpes simplex Infections such as viral hepatitis, Rubella, chickenpox, Syphilis, Toxoplasmosis, Cytomegalovirus infection, Coxsackievirus infection, Zika infection can cause abnormalities in the unborn baby.
Use of certain drugs and substances: Tobacco, alcohol, cocaine and some harmful drugs during pregnancy may cause the baby to be born with anomalies.
Polyhydramnios: Excess water of the mother can cause severe shortness of breath and premature birth. The causes of polyhydramnios can be uncontrolled gestational diabetes, multiple pregnancy, blood incompatibility, the baby's esophagus not forming, anencephaly (the baby's lack of brain) and spina bfida.
Oligohydramnios: The mother's water is less than normal. The baby may have an abnormality in the urinary tract. Oligohydramnios is a condition that prevents the baby from growing. In some babies, it was observed that the lungs did not develop adequately (pulmonary hypoplasia)
Multiple pregnancy: Pregnancies with more than one baby are in the risky pregnancy class. Multiple pregnancies may result in growth retardation in babies, premature birth, congenital anomalies in babies, uterine atony and abnormal bleeding after birth, and premature separation of the placenta. they are passed. Pregnant women who have given preterm delivery before are at high risk of giving birth again prematurely.
Women who have had a stillbirth before are considered risky pregnant. Rh blood group incompatibility between mother and baby.
What Risks Occur during Birth?
Amniotic fluid embolism: It is a rare but urgent condition that is generally seen in 2-6 per 100,000. is the problem. The mother's blood pressure drops and coagulation disorder develops. The exact cause is unknown, but there are some risk factors. The most common risk factors are cesarean delivery, advanced maternal age, abdominal trauma, placenta previa (abnormal location of the baby's partner), uterine rupture, injury to the cervix and polyhydramnios. Amniotic fluid embolism usually occurs shortly after birth. The mother may have respiratory distress, palpitations, drop in blood pressure and sudden cardiac arrest. There is bleeding from the uterus and the incisions. There may be some damage to the baby. Prolonged delivery may pose a risk for both the baby and the mother. . As a result, it can cause the baby to be deprived of oxygen. Rarely, uterine rupture may occur.
How to Follow Pregnant Women at Risk?
Ideally, women who are considering getting pregnant should go to a doctor before pregnancy. Some of the diseases mentioned above worsen with pregnancy and pose a risk for the mother and the baby.
Initial recommended doctor visit 6-8. between weeks. Follow-up is recommended at 4-week intervals up to 28 weeks, and at 2-week intervals between 28-36 weeks. Then the follow-ups are increased and the pregnant woman is seen once a week. If the pregnancy is very risky, doctor visits are made more frequently, and if it is low risk, less frequently.
At the first examination, the physician carefully questions the background of the expectant mother. Pre-existing diseases are detected. The number of hereditary diseases, children with genetic disorders, miscarriages and stillbirths in the family is important. A physical examination and ultrasound are then performed. Complete blood count, hepatitis B virus determination, maternal and paternal blood groups, liver and kidney tests, urinalysis, rubella test, fasting blood sugar, thyroid tests and sugar loading test are requested from the expectant mother. If the mother has a recent smear result, it is evaluated.
12-14. In weeks, a detailed ultrasound is performed on the mother and the nuchal translucency of the baby is checked. If necessary, the baby's heart is examined with Doppler ultrasound. In addition, a double screening test may be requested during this period. In the meantime, both the nuchal translucency of the baby is checked by ultrasound and a blood test is requested from the mother. Thus, the diagnosis of genetic diseases such as Down syndrome can be made early.
At the controls between 14-28 weeks, it is tried to determine whether there is any disability in the baby. For this, detailed ultrasound, Doppler blood flow measurement from the mother's womb, fetal echocardiography if there is a risk, blood count, blood sugar and urinalysis are performed. If necessary, amniocentesis can be performed in these weeks. The mother's blood pressure is measured each time.
Tetanus vaccine is given at the 20th week if the mother has not vaccinated against tetanus in the last 5 years. NST measurement in weekly follow-ups from the 37th week of pregnancy and amniotic fluid measurement.
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