Pregnancy (gestation) is the physiological process of a developing fetus within the maternal body. The term high risk pregnancy is used by health care providers to demarcate a pregnancy in which a mother, her foetus or both are at higher risk of developing complications during pregnancy or child birth than in a normal pregnancy. Women with high-risk pregnancies should receive care from a special team of health care providers to ensure the best possible outcomes.
High risk pregnancy may result because of various conditions which are there either before getting pregnant such as diabetes or high blood pressure, and complications from a previous pregnancy, or conditions during pregnancy or delivery.
In India about 20-30% pregnancies belong to high risk category, which is responsible for 75% of perinatal morbidity and mortality. Early detection and effective management of high risk pregnancy can contribute substantially in reduction of maternal and foetal adverse outcomes.
Pradhan Mantri Surakshit Matriva Abhiyan is an initiative of Ministry of Health and Family Welfare Government of India to identify high risk pregnancies early and follow them so that they can be referred to health care centers with proper facilities so that women with high risk pregnancies may have healthy pregnancies and deliveries without complications.
References
https://www.nichd.nih.gov/health/topics/high-risk
Jaideep KC, Prashant D, Girija A. Prevalence of high risk among pregnant women attending antenatal clinic in rural field practice area of Jawaharlal Nehru Medical College, Belgavi, Karnataka, India. Int J Community Med Public Health 2017;4:1257-9. Accessed from https://www.ijcmph.com/index.php/ijcmph/article/view/1074
If some conditions are associated with pregnancy than it is listed as high risk pregnancy* such as
Following warning signs require immediate visit to the doctor/ health facility
Reference-
https://pmsma.nhp.gov.in/wp-content/uploads/2016/10/High-Risk-Conditions-in-preg-modified-Final.pdf
Though any pregnancy could develop complications during or after pregnancy and child birth, but a pregnancy with high risk factor poses higher than normal risk for the pregnant women and fetus.
Some common high risk conditions of pregnancy are:
Maternal age: Early childbearing is a risk for both mother and new born. Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years. And newborns can have higher risks of low birthweight, preterm delivery, and severe neonatal problems.
Advanced maternal age (defined as childbearing in a woman over 35 years of age) is reported to be associated with various pregnancy complications such as risk of stillbirth, foetal growth restriction, an increased risk of caesarean birth, premature birth, birth defects, multiple births, gestational diabetes, high blood pressure, preeclampsia.
Medical conditions that exist before pregnancy, such as high blood pressure, diabetes, sexually transmitted diseases or being HIV positive, kidney diseases, autoimmune diseases, thyroid diseases can present risks for the mother and/or her unborn baby.
Medical condition that occur during pregnancy may affect pregnancy and outcome such as preeclampsia, gestational diabetes, placenta previa, polyhydramnios and oligohydramnios.
Multiple births. The risk of complications is higher in women carrying more than one fetus (twins and higher-order multiples). Common complications include preeclampsia, premature labor, and preterm birth.
Obesity. Being obese before pregnancy is associated with a number of risks for poor pregnancy outcomes.
Alcohol, tobacco and substance use- Drinking alcohol during pregnancy can increase the baby’s risk for fetal alcohol spectrum disorders (FASDs), sudden infant death syndrome, and other problems. Smoking during pregnancy may cause fetus at risk for preterm birth, birth defects, sudden infant death. Secondhand smoke also puts a woman and her developing fetus at increased risk for health problems.
Zika infection: Infection with zika just before and during pregnancy is a risk factor for different problems with the brain and nervous system of foetus, pregnancy loss and stillbirth.
References-
https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy
https://www.marchofdimes.org/complications/pregnancy-after-age-35.aspx)
https://www.cdc.gov/chronicdisease/resources/publications/aag/maternal.htm
https://www.nichd.nih.gov/health/topics/high-risk
During antenatal visits following points are important during examination :
Reference-
https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-care-checks-tests/
https://www.nhp.gov.in/sites/default/files/anm_guidelines.pdf page 23-24
Management of high-risk pregnancy depends on the woman’s specific risk factors. In a high-risk pregnancy, healthcare providers keep a close watch on the woman and the pregnancy to detect any potential problems as quickly as possible so that treatment can start before the woman’s or fetus’s health is in danger.
Following conditions are listed to level as high risk pregnancy*
Following warning signs require immediate visit to the doctor/ health facility
Under PMSMA, high risk cases get additional counseling on ‘where to go for regular checkup and institutional delivery, whom to contact during emergency’, and the contact details for assured transport. All high risk cases should be advised to visit the health facility near term in order to plan her delivery.
The main objective of the campaign is to ensure that all high risk pregnant women are detected early and provided timely and quality treatment ensure a healthy mother and a baby. PMSMA centers’ linking with comprehensive emergency obstetric and new born care (CEmONC) facilities is of utmost importance to ensure assured referral of all High risk pregnant women to appropriate facilities- first referral units (FRUs) and follow up on the outcomes.
References-
https://www.nichd.nih.gov/health/topics/high-risk
*https://pmsma.nhp.gov.in/wp-content/uploads/2016/10/High-Risk-Conditions-in-preg-modified Final.pdf
https://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/PMSMA_Operational_Framework.pdf
High risk pregnancy can not be always prevented. Staying healthy before and during pregnancy is a way to reduce the chances of high risk pregnancy.
Intake of folic acid before and during pregnancy, eating a healthy diet and maintaining proper weight, getting regular physical activity, avoiding tobacco, alcohol and substance abuse are some important factors that should be followed.
If there is any medical condition it is important to consult the health care provider before getting pregnant.
Women with high-risk pregnancies should receive care from a special team of health care providers to ensure the best possible outcomes.
The treatment guidelines for various high risk factors of pregnancy that have been prepared by the MoHFW in consultation with the technical experts are available on the NHM website*. These guidelines aim to standardize and ensure quality of care across all health facilities in the country, within the framework of the National Health Mission.
References-http://www.nrhmtn.gov.in/guideline/high_risk_pregnancy_admission_PHC_guidelines.pdf
*https://pmsma.nhp.gov.in/wp-content/uploads/2016/10/High-Risk-Conditions-in-preg-modified-Final.pdf
