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, women over the age of 35 having their first child, 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 having 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 fact that there has been an 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 such as placental abruption and uterine rupture. When high-risk conditions during pregnancy and birth are not properly managed, a birth injury may occur, leaving the baby with a lack of oxygen in her brain and hypoxic ischemic encephalopathy (HIE), neonatal encephalopathy (NE), cerebral palsy, a seizure disorder, periventricular leukomalacia (PVL), intellectual disabilities and 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 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 getting 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. Macrosomia can cause major problems for the baby because delivery becomes more difficult. 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 oxyen 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 to the baby 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, which can cause hypoxic ischemic encephalopathy (HIE). Babies that experience IUGR are also at risk of having 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 mother with even mild preeclampsia can rapidly progress to 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 the mother developing gestational diabetes, having a macrosomic baby, giving birth prematurely, and having 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 having birth complications, but women who gain 35 pounds or more during pregnancy are at risk of having a forceps or vacuum extraction delivery, both of which increase a baby’s chance of having an intracranial hemorrhage (brain bleed). Obesity also increases the risk of a cesarean delivery.
Due to the impact on the baby, it is very important that physicians properly advise expecting mothers of weight-related issues, as well as women who are trying to get pregnant.
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 3 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 having cerebral palsy, especially when labor and NICU care are mismanaged.
First time pregnancy
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 also cause a pregnancy to be 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 the child to have intellectual disabilities and developmental delays.
Women who smoke while pregnant put their babies at risk of having birth defects and long term health problems, as well as experiencing 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 preeclampsia and other high-risk conditions are having 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:
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Video: High-Risk Pregnancy Attorneys Discuss the Causes of and Treatments for Birth Asphyxia and Hypoxic Ischemic Encephalopathy (HIE)
Watch a video of attorney Jesse Reiter discussing complications – such as the umbilical cord being wrapped around the baby’s neck – that can cause a lack of oxygen to the baby’s brain, hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Jesse emphasizes the importance of a quick C-section delivery to prevent brain injury.