Almost 20% of women will experience some sort of complication during pregnancy, putting them in the category of a “high risk” pregnancy. If you are experiencing a high risk pregnancy, you are certainly not alone.
Some conditions are more common during high risk pregnancies than others. The good news is that most of these conditions can be managed by a maternal-fetal medicine physician (perinatologist) specially trained in protecting you and your baby’s health.
Just because you have previously given birth once, and sometimes twice, via Caesarean section (C-section) doesn’t necessarily mean you have to have another C-section. Many women are candidates to try to have a vaginal birth after Caesarean (VBAC) to avoid the risks and recovery of a C-section.
However, a VBAC can be a riskier delivery than a typical vaginal birth. That’s because the scar from your C-section can cause that part of your uterus to be weak. Due to the stresses of labor, your uterus might open at the scar, which is cause for an emergency C-section and may put the baby at risk. Fortunately, this is very uncommon. More than 70% of VBAC attempts result in a successful vaginal delivery.
From your very first appointment, you should let your doctor know that you are interested in a VBAC. They can help you determine if it is safe for you and your baby.
Preeclampsia occurs when you have high blood pressure due to pregnancy. Preeclampsia can also damage your organs, like your kidney and liver, and may cause seizures. While you can lower your risk for preeclampsia by living a healthy lifestyle, and in certain cases, by taking a baby aspirin daily, you can’t eliminate your risk entirely. It is most common in the first pregnancy.
The treatment for preeclampsia is to give birth. After you have delivered your baby and the placenta, your blood pressure should lower. If you are 37 weeks or later in your pregnancy, your doctor will likely deliver you to protect you and your baby’s health.
Before 37 weeks of pregnancy, your doctor might admit you to the hospital to control your blood pressure and to monitor you and your baby. The goal is to keep your baby growing in your uterus as long as possible without damaging your health. You and your doctor will have to work together to determine the right time for your baby to be born.
Pregnancy can put a lot of stress on your heart. You have additional blood in your body during pregnancy to help support the baby. However, that extra blood means your heart must pump harder to keep your blood flowing.
If you have a heart condition before getting pregnant, you might need extra care during your pregnancy to monitor your health. You might undergo electrocardiograms or echocardiograms to see how your heart is working.
You may need to deliver the baby early. Although most mothers with heart conditions can safely have a vaginal delivery, in some cases you might need to avoid labor, which may put additional stress on your heart, and have a C-section instead. Your MFM and cardiologist will make this determination based on what is best for your particular condition, and discuss it with you.
Some medicines can help control heart conditions during pregnancy. Light exercise and plenty of rest are also important to keep your heart healthy.
One of the most important things you can do to help stay healthy during pregnancy is to talk to your doctor about your heart condition before becoming pregnant. They can help you understand what you can do to protect your heart before your pregnancy begins.
4. Gestational Diabetes
Gestational diabetes is diabetes that only occurs during pregnancy. It is caused by hormones produced by the placenta, though your risk may be higher if you are overweight or have polycystic ovary syndrome (PCOS). Women who have borderline diabetes before becoming pregnant are also at higher risk.
Fortunately, you have many safe treatment options for gestational diabetes to protect you and your baby. You can change your diet and get more exercise to lower your blood sugar. You can also take medicines like insulin to help improve blood sugar.
If you have gestational diabetes, you’ll need to monitor your blood sugar throughout your pregnancy and have more frequent check-ups. Luckily, your blood sugar should return to normal after you give birth.
If you think there is a possibility that you have borderline diabetes or regular diabetes, it is important that you speak with your doctor before you become pregnant to make sure your blood sugar is in good control. High blood sugars before pregnancy can increase the risk for miscarriages and birth defects.
5. Placenta Accreta
Of all the conditions on this list, placenta accreta may be the most high risk. If you have placenta accreta, it means your placenta is growing deep into the wall of your uterus. When you give birth, the placenta usually separates from the uterus on its own after your baby is born. However, with placenta accreta, your placenta does not detach from the uterus, and may even grow into surrounding organs like the bladder. This can cause severe and life-threatening bleeding at the time of delivery.
Placenta accreta can often be diagnosed during prenatal ultrasounds. If you receive this diagnosis, you’ll likely need to give birth via C-section a few weeks earlier than planned at a hospital with resources to care for this disorder (not all hospitals have this capability). The goal is to prevent you from going into labor too early and experiencing bleeding as well as to have you deliver in the right location in a well controlled manner.
To prevent excessive bleeding at delivery, most women with placenta accreta will need a hysterectomy (removal of the uterus) immediately after giving birth. This is called a cesarean hysterectomy. Without a uterus, you won’t be able to become pregnant again. However, a hysterectomy is often necessary to save your life in this situation.
The Memorial Healthcare Maternal-Fetal Medicine specialists are experts in caring for all these conditions and more. If you need care for a high-risk pregnancy, you can trust us to provide a unique blend of family-centered care and leading treatments to meet both you and your baby’s needs.
Learn more about our high-risk pregnancy services.