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Managing a High-Risk Pregnancy

by Lindsey Getz

A high-risk pregnancy can be scary, but it’s definitely manageable.

Pregnancy can be one of the most exciting times in a woman’s life. But for those who have been told they have a high-risk pregnancy, it can also be the scariest.

There are many factors that can come into play for a pregnancy to be considered high risk. In fact, some are much more common than others. According to Dr. Eric B. Grossman, of Advocare Premier OB/GYN of South Jersey, a pregnancy being considered “high risk” could be as simple as the woman being 35 years old at the time of her due date. Or it could be as complicated as a woman with major heart disease whose life could be put in danger during a pregnancy.

Some women are also predictably high risk, such as those with pre-pregnancy conditions like diabetes or hypertension, continues Grossman. Since these conditions are already known factors, they are often well controlled before becoming pregnant.

A pregnancy will also be considered high risk if there are multiples, adds Amanda Berger, with Delaware Valley Institute of Fertility and Genetics. Although the large majority of multiple pregnancies do result in healthy babies, a pregnancy of twins or more is still considered high risk.

Conditions that arise during pregnancy, such as an abnormal placenta, gestational diabetes or pre-term labor, are a little trickier since they can only be dealt with once they are identified, says Grossman. While these issues can often also be managed well, it’s incredibly important that they’re caught early. That’s why it’s critical that mothers keep up with regular prenatal care.

What’s often difficult in unidentified problems is that the patient may look and even check out as completely healthy. Dr. Ronald Librizzi, chief of perinatology at Virtua West Jersey Hospital Voorhees, says that it’s often frustrating for patients who have lived a healthy lifestyle and done “everything right” when it comes to their pregnancy, but still run into complications.

“When someone is so healthy you just expect that they will have a normal outcome,” Librizzi says. “It just goes to show that these complications can occur to anyone in the general population and we can’t always tell when it’s going to happen. I think there’s often this misconception that complications in pregnancy can be prevented if the patient lives a healthy lifestyle. As a result, there is often a lot of guilt when something does go wrong—as though it’s something they could have prevented. That’s one of the biggest things I try to get through to my patients—to let go of that guilt.”

Dispelling the fear
There’s no question that being told you have a high-risk pregnancy can be a frightening experience. But patients should also realize that being defined as “high risk” doesn’t automatically mean your pregnancy will be bad or that the baby will have problems, says Grossman.

“As obstetricians we try to identify those factors that are complicating or could potentially complicate an individual’s pregnancy and define management strategies to minimize risk to mom and baby,” Grossman says. “I often tell my patients that there are things we can change—such as a bad diet—and things we can’t change—such as age. We should fix the things we can fix and then manage the other things as best we can to keep everybody as healthy as we can until it’s time for delivery.” Once a pregnancy is deemed high risk, the mother can expect extra monitoring, adds Berger.

“At 32 weeks, they typically have bi-weekly non-stress tests to evaluate the well-being of the baby,” Berger says. “They also go for more frequent growth scans [ultrasounds].”

Some patients may also be put on bed rest, though Grossman says there is little evidence for strict bed rest, with a few exceptions. In fact, he says that lying in one spot for hours at a time can increase the risk for blood clots, which is a serious complication.

“For patients who need to be out of work for complications like hypertension or pre-term labor, I generally describe it as ‘modified bed rest’ or ‘couch potato rest.’ In other words, you can wake up in the morning, go downstairs and have breakfast, then go lie on the couch and read a book or watch TV. You can get up to go to the bathroom, but then go back to the couch.”

Grossman says that doing things like eating or showering in between resting periods gives you a chance to move your legs and keep the blood flowing, which is important.

With high-risk pregnancies, Berger says there is always the chance that delivery could come earlier than anticipated. If frequent monitoring reveals that it would be best for maternal and fetal health, an induction or C-section could possibly be scheduled prior to that 40-week mark.

Every pregnancy and situation is going to have its own nuances, but being informed can also help dispel some of the fear. Librizzi says that information is absolutely key.

“I want patients to be knowledgeable,” he says. “A little bit of knowledge is a dangerous thing. The more information the patient has, the better. There are many options out there today including incredible non-invasive tests that can evaluate mom and baby. But you need to be in touch with your doctor. Some people are so scared that they avoid us and that’s a shame because there are excellent resources available. The vast majority of people, with the right support, can have a successful pregnancy.”

Resources

Advocare Premier OB/GYN of South Jersey
903 Sheppard Rd.
Voorhees
(856) 772-2300
151 Fries Mill Rd.
Turnersville
(856) 772-2300
AdvocareDoctors.com/PremierOBGYN

Delaware Valley Institute of Fertility and Genetics
6000 Sagemore Drive
Marlton
(856) 988-0072
StartFertility.com

Virtua Maternal Fetal Medicine
100 Bowman Drive
Voorhees
(856) 247-3326
Virtua.org

Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 6, Issue 4 (June, 2015).
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