High-Risk Pregnancy at Can Hastanesi

What is a high-risk pregnancy?

A pregnancy is considered high-risk when there are conditions that may endanger the health of the mother and baby before or after birth. What matters is identifying these factors that pose a risk to both mother and baby in advance and trying to minimize the potential risk. Sometimes, for one or more of the reasons below, the mother and baby need to be followed, once or many times, by physicians specialized in high-risk pregnancy. These reasons are:

1. Problems the mother had before pregnancy [e.g., a history of infertility, pregnancy loss (miscarriage), etc.]
2. Problems that develop in the mother during pregnancy [e.g., preeclampsia, etc.]
3. Problems that occur in the baby during pregnancy [e.g., growth restriction, etc.]

First, the factors that increase risk in pregnancy should be identified, and a pregnancy care and follow-up protocol should be established accordingly. Existing health problems, genetic diseases, age, lifestyle, habits, adverse events in previous pregnancies and complications arising in the current pregnancy should all be evaluated.

Genetic Factors and High-Risk Pregnancy

If there is a family history of inherited disease, the necessary genetic counseling should be provided before the pregnancy is planned. No question the family has on this subject should be left unanswered. The roadmap to be followed in the pregnancy should be explained to the family in detail. Sometimes certain genetic diseases may be diagnosed during pregnancy follow-up even without any family history of genetic disease. The follow-up and treatment plan for these conditions is again determined by physicians specialized in this field after a detailed discussion with the family. Such diseases are diagnosed during routine ultrasound, amniocentesis or fetal blood sampling.
How does age affect pregnancy?

With advanced maternal age, the frequency of many adverse conditions encountered in pregnancy increases. Age 35 and above is classified as advanced maternal age.

Adolescent pregnancies are those at age 18 and under. In these pregnancies, too, there is an increase in certain undesirable outcomes such as low birth weight, preeclampsia and preterm birth.

Common Health Problems Affecting Pregnancy

1. Problems before pregnancy

• Anemia
• Cancer
• Diabetes
• Epilepsy
• Heart and kidney diseases
• High blood pressure
• Infertility and a history of medication use for it
• Polycystic ovary syndrome
• Rheumatoid arthritis
• Thyroid and autoimmune diseases
• Weight (being severely underweight or overweight)

2. Problems during pregnancy

• Anemia
• Gestational diabetes
• Preeclampsia
• Cervical insufficiency
• Placenta previa, placenta accreta and percreta

3. Other factors

• Multiple pregnancies
• An interval of less than two years between pregnancies
• Factors that led to preterm birth in a previous pregnancy

4. Habits

• Alcohol consumption
• Exposure to chemicals
• Substance addiction
• Exposure to high heat
• Living at high altitude
• Smoking
• Exposure to radiation
• Malnutrition

Management of High-Risk Pregnancies

High-risk pregnancies should be managed by physicians with sufficient experience in this field, in adequately equipped hospitals. İzmir Can Hastanesi provides care with obstetricians and pediatricians experienced in high-risk pregnancy. To this end, multidisciplinary care is offered with a delivery room and operating room available 24 hours a day, a level III adult intensive care unit and a level III neonatal intensive care unit. When needed, all our physicians in other specialties can come to the hospital as consultants within a very short time.

Tests That May Be Performed in High-Risk Pregnancies

1. Amniocentesis: Usually performed between weeks 15 and 20 of pregnancy, a needle is inserted through the mother's abdominal wall to collect fluid surrounding the baby for genetic testing.
2. Cell-free fetal DNA test: From week 10 of pregnancy onward, a blood sample is taken from the mother, the baby's genetic material circulating in the mother's blood is collected, and the baby's chromosomes are analyzed.
3. Chorionic villus sampling (CVS): Between weeks 11 and 14 of pregnancy, a sample is taken from the placenta abdominally or vaginally using a special needle for genetic testing of the baby.
4. Cord blood sampling: Usually after week 20 of pregnancy, a special needle is passed through the front of the abdominal wall to draw the baby's blood from the vessel in the umbilical cord for genetic or laboratory testing.
5. Double, triple or quadruple screening tests: These tests estimate the likelihood that the mother will give birth to a baby with certain genetic disorders, using a computer program that combines ultrasound measurements, certain maternal characteristics and some biochemical markers.
6. Ultrasound: The progress of the pregnancy is monitored with ultrasound at regular intervals from beginning to end.
7. Detailed ultrasound: Usually performed between weeks 21 and 23 of pregnancy by experienced physicians as a detailed organ and anomaly scan.
8. Fetal echocardiography: Usually performed between weeks 21 and 23 of pregnancy, and at other times if deemed necessary, this is an assessment of the baby's heart in the womb with an echo device by pediatric cardiologists.
9. NST: Usually performed in the last three months of pregnancy. The baby's heartbeat is recorded with a special device. The changes in heartbeat in response to labor contractions are also recorded.

What You Should Do in a High-Risk Pregnancy

Women with a high-risk pregnancy should talk in detail with their doctors and ask questions about their concerns. The specialized physician should leave none of their questions unanswered. If there is a known health problem before pregnancy, the necessary counseling and education should be provided before conception. The patient should be given detailed information about her condition. If you have a high-risk pregnancy or may be at risk of one, you should pay particular attention to the following.

• Attend your pregnancy check-ups regularly
• Seek medical support for coping with stress if needed
• Try to get support from family or close friends
• Be sure to get support from a dietitian for your nutrition
• Follow your doctor's recommendations on exercise
• Try to learn about your condition from reliable sources of information.