A high-risk pregnancy is a pregnancy involving any potential complications that could harm the mother and/or baby. Certain factors that make pregnancies high-risk include:
- Maternal age under 20 or over 35
- Maternal medical conditions (such as gestational diabetes, maternal hypertension, preeclampsia, obesity, and infection)
- Fetal conditions
- Multiples (twins, triplets, etc.)
- A history of obstetrical complications.
In addition to potentially endangering the mother, high-risk pregnancies increase a baby’s risk for experiencing birth injuries and birth trauma. Medical professionals are obligated to follow standard of care to properly manage high-risk pregnancies and prevent harm.
Why is it so important to identify high-risk pregnancies?
William Callaghan, CDC chief for maternal and child health stated that there is an urgent need to address the issue of maternal complications, because when things go wrong during labor and delivery, “they can go south very fast.” It is very important that physicians identify factors that can cause a woman’s pregnancy to be high-risk. High-risk pregnancies require more prenatal testing and closer monitoring than those that are not high-risk, and high-risk mothers should be referred to maternal-fetal specialists.
What makes a pregnancy high-risk?
Listed below are conditions that cause a pregnancy to be considered high-risk:
- Gestational diabetes: Women with diabetes should have their blood sugar levels properly managed before becoming pregnant. When a woman has gestational diabetes, it means that diabetes is first diagnosed during pregnancy. The woman’s body cannot make as much insulin as it needs when gestational diabetes is present, and this is very serious because insulin is needed to convert blood sugar into energy. If the condition is not properly managed, the baby can grow very large or macrosomic, which can lead to issues such as shoulder dystocia, Erb’s palsy, hypoxic-ischemic encephalopathy (HIE), and cerebral palsy (CP).
- High blood pressure and preeclampsia: High blood pressure (hypertension) can cause very serious health problems for the baby, such as a decreased flow of oxygen-rich blood through the placenta. This typically occurs around the time of labor and delivery. Hypertension can also cause kidney damage in the mother, intrauterine growth restriction (IUGR), neonatal hypoglycemia, HIE, and neonatal death. In addition to hypertension, a mother can suffer from preeclampsia during pregnancy. Preeclampsia refers to high blood pressure and either excess protein in the urine or end-organ dysfunction after 20 weeks of pregnancy, in a woman who previously had normal blood pressure. This can harm the vital organs, deprive the baby of nutrients and oxygen, and lead to eclampsia (which involves maternal seizures and is very dangerous to both the mother and baby). Due to the extreme risks associated with preeclampsia and eclampsia, many physicians deliver the babies prior to term.
- Maternal Obesity: Numerous health problems are associated with obesity during pregnancy. Obesity increases the risk of the mother developing gestational diabetes, having a macrosomic baby, giving birth prematurely, and having hypertension, preeclampsia, and prolonged labor. It also increases the chance of delivery with forceps or vacuum extractors (which poses its own risks) or via C-section. It is very important that physicians properly advise expecting mothers, as well as women who are trying to get pregnant, of weight-related issues.
- Multiple births: Being pregnant with twins, triplets, or more increases the risk of premature birth. Having a baby after age 30 and taking fertility drugs have both been associated with multiple births. Being pregnant with three or more babies increases the chance that the babies will have to be delivered by C-section. Twins and triplets are more likely to have IUGR, and babies born prematurely are more likely to have breathing problems after birth, which can lead to overventilation injuries as well as oxygenation problems and HIE. Babies born earlier than 32 weeks of gestation and that weigh less than 3.5 pounds are at a substantially greater risk of developing cerebral palsy, especially when labor and NICU care are mismanaged.
- Other health conditions: Health conditions such as polycystic ovary syndrome, kidney disease, autoimmune disease, thyroid disease, and HIV/AIDS also cause a pregnancy to be high risk.
- Alcohol consumption and cigarette smoking: These are both very dangerous for the developing baby. Medical professionals should discuss the risks of these substances with pregnant mothers (and indeed, all patients).
- Advanced maternal age: Women over the age of 35 are at an increased risk of having prolonged or arrested labor, needing a C-section delivery, experiencing delivery complications such as excessive maternal bleeding during labor, and having a baby born with hypoxic-ischemic encephalopathy. Advanced maternal age also increases the chance of genetic conditions such as Down syndrome.
How is high-risk pregnancy treated?
In addition to carefully monitoring a mother and baby during a high-risk pregnancy and providing proper treatment when necessary, the physician must implement a regimen of fetal surveillance to determine what effects high-risk conditions have on the baby. Surveillance and testing should include weekly non-stress tests, biophysical profiles, and ultrasound examinations to assess the level of amniotic fluid and to determine if the baby is growing normally. Failure to do this, or to intervene when the mother or baby is in danger, is negligence. If this negligence results in harm, it constitutes medical malpractice.
Trusted Detroit, Michigan Birth Injury Attorneys
Birth injury is a difficult area of malpractice law to pursue due to the complex nature of the medical records. The award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers have decades of joint experience with birth injury, hypoxic-ischemic encephalopathy (HIE), and cerebral palsy (CP) cases, many of which have involved mismanagement of high-risk pregnancies. To find out if you have a case, contact our firm to speak with one of our lawyers. We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case. We give personal attention to each child and family we help, and are available 24/7 to speak with you.
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