A high risk pregnancy is one in which some condition puts the mother, the developing fetus, or both at higher-than-normal risk for complications during or after the pregnancy and birth.
A pregnancy can be considered a high-risk pregnancy for a variety of reasons. Factors can be divided into maternal and fetal. Maternal factors include age (younger than age 15, older than age 35); weight (pre-pregnancy weight under 100 lb or obesity); height (under five feet); history of complications during previous pregnancies (including stillbirth, fetal loss, preterm labor and/or delivery, small-for-gestational age baby, large baby, pre-eclampsia or eclampsia); more than five previous pregnancies; bleeding during the third trimester; abnormalities of the reproductive tract; uterine fibroids; hypertension; Rh incompatability; gestational diabetes; infections of the vagina and/or cervix; kidney infection; fever; acute surgical emergency (appendicitis, gallbladder disease, bowel obstruction); post-term pregnancy; pre-existing chronic illness (such as asthma, autoimmune disease, cancer, sickle cell anemia, tuberculosis, herpes, AIDS, heart disease, kidney disease, Crohn’s disease, ulcerative colitis, diabetes). Fetal factors include exposure to infection (especially herpes simplex, viral hepatitis, mumps, rubella, varicella, syphilis, toxoplasmosis, and infections caused by coxsackievirus); exposure to damaging medications (especially phenytoin, folic acid antagonists, lithium, streptomycin, tetracycline, thalidomide, and warfarin); exposure to addictive substances (cigarette smoking, alcohol intake, and illicit or abused drugs). A pregnancy is also considered high-risk when prenatal tests indicate that the baby has a serious health problem (for example, a heart defect). In such cases, the mother will need special tests, and possibly medication, to carry the baby safely through to delivery. Furthermore, certain maternal or fetal problems may prompt a physician to deliver a baby early, or to choose a surgical delivery (cesarean section) rather than a vaginal delivery.
Most women will see one healthcare provider during pregnancy, either an obstetrician, a midwife, or a nurse practitioner. Women who have a medical problem may need to see a medical specialist as well. Women diagnosed with a high-risk pregnancy may also need the expert advice and care of a perinatologist.
A perinatologist is a medical doctor (obstetrician) who specializes in the care of women who are at high risk for having problems during pregnancy. Perinatologists care for women who have pre-existing medical problems as well as women who develop complications during pregnancy.
Il professor Claudio Giorlandino dirige il centro di eccellenza di Medicina Materno-fetale presso Altamedica Main Center Roma.