High risk pregnancy

introduction

A pregnancy is classified as a high-risk pregnancy if the pregnant woman has risk factors that can lead to complications for the mother or child during the pregnancy. These can be derived from the anamnesis (Pre / medical history) or after the examination of the expectant mother or in the event of complications during pregnancy.
A high-risk pregnancy means more intensive care for mother and child. For example, the intervals between visits to the gynecologist are shorter, there are more frequent ultrasound examinations of the pregnancy or special examinations carried out.

The twin pregnancy is one of the high-risk pregnancies. Learn more about it: Twin Pregnancy - What You Should Know!

classification

Anamnestic (pre-existing) Risk factors are the age of the mother (under 18 years, over 35 years), Diseases of the mother or within the family (e.g. Diabetes mellitus, high blood pressure, epilepsy, very overweight, infections) and previous operations, malformations or fibroids of the uterus.
A high-risk pregnancy also exists with a previous caesarean section, more than five births in the past, a rapid succession of pregnancies (less than a year) and complications from previous pregnancies or births (see below).
The use of medication, drugs, and alcohol can also lead to a high-risk pregnancy.

Read more about Medication in Pregnancy and Alcohol in Pregnancy and Epilepsy and Pregnancy

Smoking during pregnancy also carries many risks for the pregnancy and the unborn child.

Read more on the subject below How dangerous is smoking during pregnancy?

Various risks can arise during pregnancy that require more intensive care for mother and child. These include the appearance of Anemia (Anemia), the appearance of Bleeding, one Blood group intolerance (Rh factor incompatibility), one Placenta misalignment (Placenta previa) or another one Placenta disease, one Cervical weakness and premature labor.
Other factors of a high risk pregnancy are the diagnosis of various Infections in pregnancy, one Gestational diabetes, one High blood pressure during pregnancy or one pre-eclampsia (Poisoning during pregnancy).

Age of mother

Are women in pregnancy younger than 18 years or older than 35 years (from the second child older than 40 years), pregnancy is called High risk pregnancy classified. Among other things, it is more common in very young women premature labor and Premature births.

In women over 35 years of age are Chromosome changes such as. Trisomy 21 (Down syndrom) more often and the risk of Miscarriage is higher. Older women are more likely to have pre-existing conditions that lead to classification as a high-risk pregnancy. It is also more common to develop one in the course of pregnancy Gestational diabetes, High blood pressure or one thrombosis.

Investigations

In the case of a high-risk pregnancy, the pregnant woman and the growing child receive intensive care. This includes more frequent visits and ultrasound examinations to the gynecologist and there can be special examinations as part of the Prenatal diagnostics be performed. Additional exams include:

• Chorionic villus sampling: from the 6th week of pregnancy, puncture of the mother cake (invasive), Detection of chromosome changes and metabolic diseases

• First trimester screening: around 11-13 SSW, blood sample from the mother and ultrasound examination, evidence of trisomy 21 (Down syndrom)

• Amniocentesis: from the 13th week of pregnancy, amniocentesis (invasive), Evidence of a genetic disease

• Neck fold measurement: 11th – 14th week of pregnancy, ultrasound examination, detection of chromosomal changes or a heart defect
• Prenatal test: from the 11th week of pregnancy, blood sample from the mother, evidence of chromosome changes
• Triple or quadruple test: 15.-18. SSW, blood sampling from the mother, detection of chromosome changes or malformations such as Neural tube defects

• Umbilical cord puncture: from the 18th week of pregnancy, puncture of the umbilical cord (invasive) and examination of the child's blood

• Fine ultrasound: 19. – 22. SSW, ultrasound examination of the child's organs, exclusion of developmental changes

The costs some of these examinations mentioned are in the case of a high risk pregnancy from the legal Health insurance accepted.

History of previous pregnancies

If in the course previous pregnancies or births certain Events or Complications occurred, this may lead to the current pregnancy being classified as a high-risk pregnancy. These include Abortions, Miscarriages, Premature births, one Blood group intolerance (Rh incompatibility), the Birth of a very small or very large child, a Caesarean section in the past and one previous or existing multiple pregnancy. Also the appearance of Thrombosis, Bleeding or Injuries during previous births pose risks.

Please also read: Childbirth complications

Complications

A number of complications can arise during a high risk pregnancy that arise from the risks listed above. For one that has not been adequately treated Gestational diabetes the mother can too Developmental disorders of the placenta and thus to Under-provision of the child come. Besides, the child can very large become (> 4350g), which is a danger in a spontaneous (vaginal) Can represent birth. After the birth, the child's blood sugar must be closely monitored, since severe hypoglycaemia may occur.

At a pre-eclampsia (Poisoning during pregnancy) complications such as eclampsia (Increase in symptoms of pregnancy poisoning and seizures) or a so-called HELLP syndrome come. These can be very dangerous for mother and child, so that the birth should usually be initiated immediately.

Read more on the subject here initiate birth

Infections in pregnancy can increase depending on the cause Risk of miscarriage and premature birth represent and it can too Developmental disorders and Malformations come.

At a Caesarean section in the past women have an increased risk of having a subsequent pregnancy and spontaneous delivery Rupture (Crack) the uterusbecause scar tissue is more unstable than normal tissue.
To more than five births A history of the child is at greater risk of insufficient oxygen and nutrients from an Placental insufficiency and for Complications in the course of childbirth.

At a Placenta misalignment can Bleeding bleeding increases the risk of miscarriage or premature birth.

At a Blood group intolerance it can become a strong one Anemia and undersupply of the child come after the birth can come a Neonatal icterus (Jaundice) develop.
A Anemia of the mother If left untreated, it can lead to an undersupply of mother and child.

Employment ban

The Maternity Protection Act determines, among other things, protection periods like that Employment ban. One differentiates between one general, one general as well as one in the case of a high-risk pregnancy individual employment ban.
The general prohibition of employment applies 6 weeks before the calculated delivery date and 8 weeks (12 weeks for multiples) after birth. A general employment ban can be implemented depending on the professional activity the expectant mother.

The individual prohibition of employment comes into play in the case of a high-risk pregnancy and is justified individually by the doctor, if in continuation of employment Dangers for the mother or the growing child consist. The doctor can do this partial (certain activities may no longer be carried out or changes in working hours) or total employment ban attest.
The inability to work is to be distinguished from this. During a ban on employment outside the normal protection periods, the employee is entitled to one Maternity leavethat the full pay corresponds.

also read Can I fly while pregnant?

Summary

A high-risk pregnancy is when, due to various risk factors during pregnancy or at birth, a Endangering the health of mother and child can exist. These can be derived from the Prehistory of the expectant mother (i.a. Illnesses, previous pregnancies) and from Complications During Pregnancy surrender.

If a pregnancy is classified as a high-risk pregnancy, the mother and child will gradually become more intensive care and, if necessary, specifically selected hospitals for delivery. In the case of a high-risk pregnancy, ultrasound examinations can also be performed more frequently additional examinations prenatal diagnostics, some of which are paid for by the statutory health insurance companies. Depending on the cause of a high-risk pregnancy and its course, the attending physician may advise individual employment ban attest.