High-risk pregnancies are pregnancies where either the mother or child has a risk of developing or experiencing some form of severe health issue. In recent years, the number of pregnancies classified as high-risk has dramatically increased, along with the number of pregnancies with severe complications. Factors that can make a pregnancy high-risk include maternal diabetes, high blood pressure and preeclampsia, maternal obesity, having multiple children at once, autoimmune disorders, HIV/AIDS, and the use of alcohol and tobacco during pregnancy.
High-Risk Pregnancy and Birth Trauma
The number of high-risk pregnancies in the U.S. has risen dramatically. A high-risk pregnancy is one in which the mother or baby has an increased chance of a health problem. Coinciding with the increased number of high-risk pregnancies is the sharp increase in the rate of severe complications that occur during labor and delivery. A significant reason for the increase in complications is the increase in the number of pregnant women who are obese, older, or have long-term conditions such as diabetes. When a woman has one or more of these conditions, her pregnancy is considered high-risk. Healthy women can also experience serious complications during childbirth, such as severe bleeding caused by conditions like placental abruption and uterine rupture. When high-risk conditions during pregnancy and birth are not properly managed, a birth injury may occur, leading to a lack of oxygen in the brain and hypoxic-ischemic encephalopathy (HIE), neonatal encephalopathy (NE), cerebral palsy, a seizure disorder, periventricular leukomalacia (PVL), intellectual disabilities, or developmental delays. When conditions such as placental abruption occur and a baby is in distress, a C-section is often the fastest and safest way to deliver the baby.
Two years ago, William Callaghan, the chief of the maternal and child health bureau of the Centers for Disease Control (CDC) 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 must have more frequent testing and closer monitoring than those that are not high-risk, and these mothers should be referred to maternal-fetal specialists.
What Conditions Make a Pregnancy High-Risk?
Listed below are 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 cause major problems for the baby because it increases the difficulty of delivery. A macrosmic baby is more likely to experience shoulder dystocia, which is when the shoulder becomes hinged or stuck on the mother’s pelvis during labor. Sometimes this causes physicians to use excessive force during delivery, and the baby can get permanent damage to the nerves in her neck and shoulder area, which can cause arm paralysis (Erb’s palsy). Large babies can also get stuck in the birth canal, placing them at risk for a lack of oxygen to the brain, brain injury, HIE, and cerebral palsy.
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, which can cause the baby to have low birth weight or intrauterine growth restriction (IUGR / small 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 hypoxic-ischemic encephalopathy, neonatal hypoglycemia, as well as neurological disorders.
In addition to hypertension, a mother can suffer from preeclampsia during pregnancy. Preeclampsia can be mild, moderate, or severe. However, a even a case of mild preeclampsia can rapidly progress into a severe form of the condition. Moderate and severe forms can harm the kidney, liver, and blood vessels. 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.
Mismanaged preeclampsia – even mild forms of the condition – can cause problems with the blood vessels of the placenta. This can lead to a decreased flow of blood to the baby, depriving the baby of adequate nutrition and oxygen. In cases of moderate to severe preeclampsia, there may be oligohydramnios (low amniotic fluid), IUGR, or placental abruption.
Due to the extreme risks associated with preeclampsia, many physicians deliver the 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. Obesity also increases the risk that a baby will have to be delivered by vacuum extraction. Not only are women who are obese prior to pregnancy at risk of birth complications, but women who gain 35 pounds or more during pregnancy are at risk of forceps or vacuum extraction use during delivery, both of which increase a baby’s chance of an intracranial hemorrhage (brain bleed).
Due to the impact on the baby, it is very important that physicians properly advise expecting mothers of the complications associated with obesity during pregnancy.
A pregnancy involving multiples gestations (twins, triplets, or more) is at increased risk for premature birth and will likely be delivered via cesarean section. Twins and triplets are more likely to have IUGR, breathing problems after birth, overventilation injuries, 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 having cerebral palsy, especially when labor and NICU care are mismanaged.
Women over the age of 35 are at an increased risk of having the following:
- Prolonged or arrested labor
- C-section delivery
- Delivery complications, such as excessive bleeding during labor, which can cause a lack of oxygen in the baby’s brain and HIE
- A baby with a genetic disorder such as Down syndrome
Other health conditions and lifestyle issues
Health conditions such as polycystic ovary syndrome, kidney disease, autoimmune disease, thyroid disease, and HIV / AIDS can also make a pregnancy high-risk.
Alcohol consumption and cigarette smoking are very dangerous for the developing baby. Alcohol passes directly through the umbilical cord to the baby. Mothers who consume alcohol during pregnancy are at a high-risk of having a stillbirth or miscarriage, and the baby is more likely to have birth defects and fetal alcohol syndrome (FASD), which can cause intellectual disabilities and developmental delays.
Women who smoke while pregnant put their babies at risk of birth defects and long term health problems, as well as sudden infant death syndrome (SIDS).
Legal Help for High-Risk Pregnancy, Birth Injury, and Medical Malpractice
Reiter & Walsh ABC Law Centers | Our Exclusive Focus on Birth Injury
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.
Birth injury law is a difficult area of law to pursue due to the complex nature of the medical records. The attorneys at Reiter & Walsh ABC Law Centers have decades of experience with birth injury cases, many of which directly involve high-risk pregnancy. From our primary office location in Detroit, Michigan, Reiter & Walsh ABC Law Centers handles birth trauma cases all over the United States, in places including Pennsylvania, Tennessee, Mississippi, Texas, Wisconsin, Michigan, Ohio, Washington D.C., Arkansas, and more. To begin your free case review, please contact us in any of the following ways:
Free Case Review | Available 24/7 | No Fee Until We Win
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.