A pregnancy is high risk when there are conditions that could compromise the health or life of the pregnant mother and / or her baby. The risk of obstetric complications can occur for the first time during pregnancy in perfectly healthy women or can be predicted for a future pregnancy in women carriers of medical illnesses of considerable severity. Fetal malformations are considered a form of high obstetric risk of fetal origin.

Considerations

It is expected that approximately 10% of normal pregnancies will have some complication that makes them a high risk pregnancy, and for the most part we will find that the cause is some form of Pregnancy-induced Hypertension (eg, Preeclampsia), Gestational Diabetes , some fetal and very few fetal infections, fetal growth and health disorders, structural anomalies of the fetus and placental problems.

The abnormal fetus generates high obstetric risk because the pregnancy deviates from its natural course and the mother will be exposed to a series of diagnostic and therapeutic procedures (amniocentesis, cordocentesis, high rate of cesareans, fetal surgery if available) that could generate complications; without forgetting the adverse effects that the anguish and stress, naturally present, could cause. A high-risk pregnancy should be expected in patients with preexisting medical conditions or diseases such as diabetes, hypertension, kidney problems, morbid obesity, autoimmune diseases, etc.

Severe chronic diseases represent the most complex scenario facing the obstetrician, the more severe and prolonged the disease, the greater the likelihood of medical or obstetric complication during pregnancy; in fact, a really serious condition with considerable organic damage can go so far as to formally contraindicate a future pregnancy or consider the interruption of an ongoing pregnancy regardless of fetal age and leaving aside considerations of embryo-fetal well-being in order to avoid maternal death. This is a devastating picture because this implies interrupting a pregnancy with a baby, usually healthy, that we know will not survive because of extreme prematurity.

Currently the mother is a priority over the fetus and there is no negotiation possible in this regard, regardless of personal, family, moral or religious considerations, pregnancy should be interrupted if it puts the mother’s life in immediate danger even if it implies the fetal death. Fortunately, it is extremely rare these days as we have better control over chronic diseases.

All obstetric and medical complications associated with pregnancy lead to a few clinical symptoms of varying severity:

1. Fetal growth disorders, placental insufficiency, acute or chronic fetal distress, fetal death.
2. Hypertensive disorders, preeclampsia, eclampsia, placental abruption.
3. Preterm labor, neonatal prematurity, rupture of membranes.
4. Increase in the frequency of Cesarean sections and emergency procedures.

When the maternal condition is normal and the problem is in the fetus the pregnancy becomes a high risk by fetal indication

1. Chromosomal abnormalities such as Trisomy 21 or Down syndrome, mental retardation in the presence of multiple organic malformations
2. Syndromatic genetic abnormalities with varying degrees of injury to the organs and systems characteristically affected, genetic mutations
3. Isolated congenital anomalies of variable severity such as spina bifida or irreversible obstruction of the fetal urinary tract
4. Multiple pregnancies

The woman of 35 and older

It is said that women over 35 may have a greater number of medical complications associated with pregnancy due to diseases acquired due to aging, but the truth is that if the patient is healthy, her pregnancy will behave like a normal pregnancy once discarded , as in all pregnant patients, abortion and fetal chromosomal problems. This is a concept that comes from past times, historical moments in which the survival of the human being was quite low (30-40 years) and in which a woman was considered over 35 as a woman over the years and not very suitable for reproduction. In addition, there was no adequate prenatal control or technological resources like today’s.

Age per se in the absence of risk factors should not suggest that pregnancy is high risk; In addition, prenatal behavior does not change drastically and unnecessary anguish must be avoided in women who believe that by the mere fact of being “older” will have a pregnancy disaster. In my experience during these 20 years I have not observed a higher frequency of obstetric complications even though the average age in my practice is around 30 years old, in fact, the most mature, prepared and adult woman is much easier to handle and that his life is more stable and self-sufficient.

Chromosomal risk : after 35 years, the risk of fetal chromosomal problems such as Down syndrome begins to be considered high and, however, in the worst case, it does not exceed 2%. There is an indication to practice amniocentesis if the patient wishes, but we have excellent non-invasive ultrasound methods and maternal blood tests, which after 11 weeks allow us to rule out a significant number of cases and thus reduce the number of invasive procedures: once the Chromosomal risk (around week 16) pregnancy becomes a low risk if there are no other factors present.

After 35, the risk of abortion increases, probably due to an increase in cases of chromosomal disorders, but most of these pregnancies will reach a happy conclusion once week 10 has passed (as it does for any pregnancy)

How do we diagnose or rule out problems?

“Every patient and / or their baby has a High Risk condition until proven otherwise”

This way of thinking leads to the prenatal control and the studies that are carried out discarding or quickly detecting a real or potential problem. Rational and practically this approach gives better results than the usual tendency to hope that everything is fine that our predecessors of obstetrics managed

We rely on the clinical history, the laboratory, the advanced sonography and the routine follow-up. If problems arise, or we start with them, we specify a multidisciplinary work team.