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High Risk Pregnancy
What is high risk pregnancy?
A high risk pregnancy is a pregnancy with a significant probability of a poor outcome for mother and / or the newborn. In some cases, these patients are identified in their first antenatal visit to the obstetrician’s office. They have a poor obstetrical past history or a well recognised medical complication. In other cases, women become high risk pregnancies because they develop unexpected complications in the course of the present pregnancy. These patients with unexpected complications are in a vulnerable emotional state due to the sudden loss of their expectations of a normal pregnancy outcome and the lack of preparedness for specialised investigations and other obstetrical interventions.
High risk patients require sophisticated maternal and fetal surveillance. In many cases difficult management decisions are needed in order to optimise the outcome for both the mother and the child.
Identification of the high risk patient
How to identify a high risk pregnancy?
A high risk pregnancy can be identified only if the woman has access to prenatal care. Poverty -limiting access to the health care system and the lack of ability of society and government to provide medical coverage to those unable to pay for these services are powerful factors that prevent access to prenatal care. Once the woman has access to prenatal care, the second limiting factor preventing the identification of those at risk is the quality of prenatal care itself, because in many cases the services provided are of marginal quality, and high risk patients are not identified.
What is preconceptional counselling?
The best time to assess the potential impact of medical and obstetrical complications on the outcome of pregnancy is before the pregnancy occurs. This is known as preconceptional counselling. During this visit the obstetrician assesses the woman’s fitness for pregnancy and / or makes the woman fit for pregnancy, so that there is a normal outcome. During the visit the obstetrician also analyses high risk factors and the life style modifications that she may need to adopt to maximise the outcome of pregnancy.
What to expect during preconceptional counselling?
Should I become pregnant?
The decision to become pregnant despite significant risks is very personal and based on a multiplicity of variables and considerations that are known only by the patient and her partner. The doctor only helps the couple understand the medical possibilities.
Another important aspect of preconceptional counselling is to give consideration to the financial burden associated with the care of a high risk pregnancy, particularly in terms of working disability. The couple should also consider the need for help with children and household duties when they are admitted to the hospital or placed on bed rest at home.