High-risk pregnancy: who are at risk? Information that is important to know

What is a high-risk pregnancy? Who are at risk from start to risk? Any chronic diseases that affect the course of a healthy pregnancy? Do you suffer from diabetes, hypertension or an autoimmune disease?

A high-risk pregnancy is a pregnancy in which the woman, the fetus, or both are at risk. Maternal condition for high-risk pregnancy is practically every maternal disease present before pregnancy, which may affect the course of a healthy pregnancy.

Any previous diseases that may lead to high-risk pregnancy?

Diseases that may lead to high-risk pregnancy are heart disease, acute or chronic infectious diseases, respiratory disease, gastrointestinal, diabetes, hypertension and others. Also, the conditions or diseases that are discovered in the mother during pregnancy may put the pregnancy at risk, such as cases of bleeding during pregnancy caused by the state of the placenta displaced or the separation of the placenta, diabetes during pregnancy, blood pressure during pregnancy, amniocentesis, delay in delivery, and others.

Can the fetus itself be dangerous to pregnancy?

With regard to the fetus, every problem associated with it - not in the proper range - may classify pregnancy as a high-risk pregnancy. For example, cases of multiple fetus pregnancy, pregnancy with an excess or decrease in the amount of amniotic fluid, congenital malformations in the fetus, slow growth of the fetus inside the womb, fetal edema and others.

In addition, every pregnancy that occurred after a pregnancy ended abnormally due to a maternal or fetal problem, it can also classify the pregnancy as a high-risk pregnancy.

Who are at risk from the start for high-risk pregnancies, even if the pregnancy progresses to its end properly?

Every woman before she gets pregnant, suffers from a chronic or acute disease, not related to pregnancy, but it may worsen during pregnancy and make it difficult to deliver - she must undergo a follow-up at a high-risk pregnancy clinic, even if during pregnancy she feels that everything is healthy and fine .

In general, it is about complex diseases linked to the body's central systems. For example: type 1 diabetes, hypertension, epilepsy, cardiovascular disease, autoimmune diseases (such as SLE or Crohn's disease), lung disease, severe asthma, renal insufficiency and endocrine diseases (such as hyperthyroidism). In addition, women who have undergone frequent miscarriages, women over the age of 35 or under the age of 18, and a pregnant woman with more than one fetus - are also considered to be women in a high-risk pregnancy.

How often should a physician be visited in the event of a high-risk pregnancy?

Follow-up with a gynecologist who specializes in high-risk pregnancies may significantly reduce some of the complications that may arise during pregnancy. Follow-up should be carried out in a medical setting specializing in high-risk pregnancies. That is, a doctor who specializes in this field has a private clinic for these cases; Or sometimes in the hospital's mother and fetus department. This follow-up is necessary in order to determine the shape of the future pregnancy follow-up, to determine the date of birth and the method of birth according to the state of the pregnancy and its severity in particular.

With regard to the frequency of pregnancy follow-up, the frequency may change and the matter of existing diseases due to which women were classified as a high-risk pregnancy, in their current medical condition during pregnancy; And if her primary disease changed - also according to the progress of pregnancy tests himself and according to the development of the fetus. If the woman, the fetus and the pregnancy, are stable and developing as expected, follow-up is done more often every four weeks.

If a permanent follow-up is required, the frequency of the doctor's visits will change accordingly; If the health condition is not stable, the woman must stay in the hospital to follow the situation closely in the maternal and fetus department.

Which tests - in addition to the regular pregnancy tests - should be done in case of high-risk pregnancy?

Unusual examinations for women who are classified as high-risk pregnancy, change according to the underlying disease or condition that resulted in the treatment being classified as a high-risk pregnancy category. If there is talk about women who were classified in this category because of pre-pregnancy diabetes, the level of glycosylated hemoglobin (A1C) should be checked once every trimester to check the sugar balance; You should also continue to undergo eye examination once every trimester. Retinal examination should be performed, fetal echocardiography to rule out fetal cardiac abnormalities, kidney performance examination (such as creatinine, urea), and 24-hour quantitative urine examination of urine should be performed once every trimester (besides monitoring diabetes / and daily status).

In addition to the tests that are performed for the mother, a fetal development test should be performed, as well as an examination of the amount of water and blood flow more frequently compared to the normal pregnancy. In the event of an autoimmune disease such as SLE, fetal echocardiography should be performed from the early weeks of pregnancy - in addition to a specific antigen test (such as an anti-RO and an-LA).

For women who are classified as dangerous, which medical examinations should be performed before entering pregnancy?

The majority of chronic diseases will affect the course of a healthy pregnancy. Therefore, the stability of these diseases must be preserved before entering pregnancy. If a woman with one of these diseases has a stable condition and is treated for pregnancy, the pregnancy is likely to be completed safely. If the disease is not stable and is not treated as it should - complications of pregnancy may appear consecutively.

In pre-pregnancy diabetes, it is important to make sure before pregnancy that the A1C level is stable and in normal range.It is also important to make sure that the treatment performed before pregnancy is an eye examination, a kidney performance test, a quantitative urine collection test - and it is very preferable that the results of these tests are stable even before entering a pregnancy.

Women with chronic hypertension, preferably from the beginning of pregnancy, take safe medicines that can be taken during pregnancy. If there is a need to change the type of treatment, this should be done before entering a pregnancy. In the event of autoimmune diseases (such as SLE), it is important for the woman to be in a state of rest (not in the case of an active illness) before she gets pregnant. Ensure that she is receiving treatment with approved medication for treatment - and that it does not harm the fetus.


Dr.. David Segal is a senior physician in high-risk obstetrics at Soroka Medical Center and at the Clalit Health Fund.