High-risk pregnancies are pregnancies in which the mother and/or baby has an increased chance of developing or experiencing a serious health issue. In recent years, American women have been giving birth at older ages, and more mothers-to-be have conditions such as diabetes and high blood pressure. Likewise, the number of pregnancies classified as high risk has increased. When properly managed, high-risk pregnancies can often result in a healthy mother and infant. However, it is very important that medical professionals be extra vigilant when treating women with high-risk pregnancies; they should also recommend that these patients consult with maternal-fetal specialists. In addition to putting mothers’ lives in jeopardy, negligent management of a high-risk pregnancy can cause babies to sustain avoidable birth injuries and develop lifelong conditions such as cerebral palsy.
What Conditions Make a Pregnancy High-Risk?
Listed below are some of the common conditions that cause a pregnancy to be considered high-risk:
Women with diabetes should have their blood sugar levels properly managed before pregnancy. When a woman has gestational diabetes, it means that diabetes is first diagnosed during her 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. Macrosomia can make vaginal delivery very difficult, sometimes resulting in issues such as shoulder dystocia, Erb’s palsy, hypoxic-ischemic encephalopathy (HIE), and cerebral palsy (CP). Diabetes can also result in placental perfusion issues causing intrauterine growth restriction (IUGR).
High Blood Pressure and Preeclampsia
Maternal high blood pressure (hypertension) can cause very serious health problems for the baby. One health problem associated with maternal high blood pressure is the decreased flow of oxygen-rich blood through the placenta, which typically occurs around the time of labor and delivery. Hypertension can also cause kidney damage in the mother, a complication which may cause low birth weight or intrauterine growth restriction (IUGR) in the baby. IUGR is associated with 60% of the neonatal deaths that occur every year. IUGR babies need to be delivered before term because they do not tolerate contractions and labor well, and can suffer from a lack of oxygen during the labor process. Babies that experience IUGR are at risk of neonatal hypoglycemia, hypoxic-ischemic encephalopathy, and other neurological disorders.
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. Cases of preeclampsia may be mild, moderate, or severe. However, even mild preeclampsia can rapidly progress into a severe form of the condition. Moderate and severe forms can cause problems with vital organs, IUGR, oligohydramnios (low amniotic fluid), and placental abruption. Moreover, improperly-managed preeclampsia can lead to eclampsia, which is when the mother has seizures during pregnancy. This can cause death of both the mother and baby.
Due to the extreme risks associated with preeclampsia, many physicians recommend delivering babies prior to term.
Numerous health problems are associated with obesity during pregnancy. Obesity increases the risk of gestational diabetes, macrosomia, premature birth, hypertension, preeclampsia, and prolonged labor. Additionally, women who gain 35 or more pounds during pregnancy often end up having assisted deliveries with forceps or vacuum extractors, which increases the risk of infant brain bleeds (intracranial hemorrhages).
It is very important that physicians properly advise expecting mothers of the complications associated with obesity during pregnancy, as well as have a discussion with them about how best to minimize risks.
A pregnancy involving multiples (twins, triplets, or more) is at increased risk for premature birth and will likely be delivered via cesarean section (C-section). Multiples are more likely to have IUGR, breathing problems after birth, overventilation injuries, oxygenation problems, and hypoxic-ischemic encephalopathy.
Babies born earlier than 32 weeks of gestation and that weigh less than 3.5 pounds (both of which are common with multiples) are at a substantially greater risk of developing cerebral palsy, especially when there is improper care during labor or in the NICU.
Women over the age of 35 are considered to be of “advanced maternal age,” and are at an increased risk of developing conditions like preeclampsia and gestational diabetes. They are also more likely to have prolonged or arrested labor and to require delivery via C-section. Certain delivery complications, such as excessive maternal bleeding during labor, are more common among older mothers and can cause the baby to develop hypoxic-ischemic encephalopathy. Finally, women over the age of 35 are more likely to have a baby with a genetic disorder such as Down syndrome.
Other Health Conditions and Lifestyle Issues
Pregnancies may be designated as high-risk if the mother has a health condition such as polycystic ovary syndrome, kidney disease, autoimmune disease, thyroid disease, or HIV/AIDS. Alcohol consumption and cigarette smoking are also very dangerous for the developing baby.
Management of a High-Risk Pregnancy
In any pregnancy, medical professionals should conduct regular tests to evaluate the health of the mother and baby. Prenatal assessments may include non-stress tests (NSTs), ultrasounds for AFI (amniotic fluid index), biophysical profiles (BPPs), and Doppler flow studies. These tests can be used to identify a number of fetal risks and pregnancy complications; concerning results may indicate that intervention is necessary.
In high-risk pregnancies, physicians often recommend more frequent and extensive testing. This is critical because careful surveillance can allow sufficient time for medical intervention if the need arises.
In particular, doctors and nurses must be vigilant for signs of fetal distress. These are indications that the baby is not receiving enough oxygen. If a baby is in distress, appropriate interventions may include the administration of oxygen, fluids, and medication to the mother, or a change in the mother’s position. Often, an emergency C-section is required in order to remove the baby from the conditions causing the fetal distress, especially if earlier interventions did not cause fetal heart tones to become reassuring. An emergency C-section should be performed within 5 to 18 minutes, depending on the circumstances, and sometimes a lot sooner.
For many patients with high-risk pregnancies, it is wise to have a planned early delivery. Physicians should discuss this option with their patients. In order to provide informed consent, patients must understand the risks and benefits of various courses of action.
It is negligence if medical professionals fail to conduct the appropriate prenatal testing for patients with high-risk pregnancies, obtain informed consent, or promptly intervene when necessary. If any of these negligent actions cause harm to a mother or baby, it constitutes medical malpractice.
Legal Help for High-Risk Pregnancy, Birth Injury, and Medical Malpractice
Reiter & Walsh ABC Law Centers | Our Exclusive Focus on Birth Injury
Birth injury is a challenging area of malpractice law to pursue due to the complex nature of the medical records. The award-winning attorneys at Reiter & Walsh ABC Law Centers have decades of joint experience with birth injury, hypoxic-ischemic encephalopathy (HIE), and cerebral palsy 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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Video: High-Risk Pregnancy Prenatal Care
In this video, nurse Andrea Shea discusses what to expect during a prenatal appointment, as well as the proper management of a high-risk pregnancy.