High Risk Pregnancy Indicators and Diagnosis (Q&A)

So, when we think about what makes a woman high risk again we typically divide it into a
maternal indication or a fetal indication or sometimes it’s the
maternal-fetal pair indication. So, thinking about maternal indications…
anytime a woman has an underlying medical condition…people often know about high blood pressure, diabetes but it could be asthma, a seizure disorder, a thyroid disorder, prior history of a corrected heart problem, you
know, renal disease, kidney disease, anything… any underlying medical problem – that
qualifies a patient for high-risk. Now within that we kind of stratify
patients in terms of high-risk-high-risk or low-risk-high-risk and we can make plans accordingly. Again, any mother issue. The other
issues that can come from the maternal side is if they’ve had a prior poor obstetrical outcome or a prior adverse outcome. Examples of that could be a woman who delivered a baby at say nineteen weeks gestation. That’s a time
when unfortunately a fetus can’t survive and so that really ends as a miscarriage and
there are many reasons why that sometimes can happen, so that’s a woman that would
be high-risk. Say it’s a woman who doesn’t have high
blood pressure but she developed something called preeclamsia, which is the high
blood pressure that’s unique to pregnancy in a prior pregnancy… she too then can be high-risk. Those are just examples. One real common one is gestational diabetes. Every pregnant woman is at risk for gestational diabetes and everybody gets screened for that. Now, in terms of the fetal indications…fetal indications typically can be a chromosomal problem…people often know about Down syndrome but there are many other chromosomal problems, a
structural anomaly with the fetus so when we’re doing ultrasound we can detect
intra cranial abnormality, cardiac abnormality, renal abnormality, bowel, pretty much any organ system that we can see by ultrasound we can and have found abnormalities in those areas and if
that’s found, that doesn’t mean the pregnancy can’t go forward, doesn’t mean the mom can’t have a vaginal delivery, doesn’t mean a mom can’t deliver at term, but it does mean that to optimize
outcome of that baby we want to make sure we have all the resources available at the time of
delivery to make sure, again that outcome is optimized. So, that would be a high risk pregnancy. And then we get this mother-fetal
pair, you know, there’s something going on with both. An example: sometimes some of the chromosomal problems can have implications for the mother and so that pair then becomes high-risk. That’s just one example. How do we diagnose problems that you know, would make a patient become our
patient? So often, with ultrasound. So, most patients when they come to our
center they are low-risk. They’re coming to make sure everything is okay. Some people may not even understand exactly what’s going to happen here…they think they’re coming to know whether they’re having a boy or girl, so with ultrasound we essentially…I always describe to patients, “We’re looking from head to toe” and what we’re looking for again are structural abnormalities that may require their baby to need special attention at the time of delivery. There are other structural abnormalities that may group together and make us more
concerned about a genetic abnormality, whether it’s a
chromosomal or non-chromosomal genetic abnormality, we’re looking for signs of that.
I would share, and I think with patients it’s important for everyone to
understand that ultrasound’s not 100%. You know, ultrasound doesn’t speak to how smart your baby’s going to be or anything like that. It’s really looking at structure. That’s all it’s really doing. We know though from our experience that some of these structures, if they’re abnormal, can lend and lead itself to other diagnoses so
that’s what we’re looking for. Other things they can come up that we’re
looking for…has nothing to with ultrasound at all… sometimes it’s something – a mom has a
condition that also may relate to another condition so a mom presents with say, diabetes, we know
diabetes can affect many organ systems… the heart, the kidneys, the eyes, so we do additional testing to see, how’s everything else going. We may actually identify another organ
system that’s affected and that may have other implications for the pregnancy. An example of that…if we go forward with the
diabetes…if we find diabetes that actually is also affecting the kidneys we know pregnancies where mom has
diabetes and also kidney disease…they’re at higher risk of having a
preterm baby, they’re at higher risk of preeclampsia, which is the high blood pressure can occur with pregnancy They’re at higher risk for developing fetuses that don’t
grow appropriately and that will then lead us to additional testing. So, we consider ourselves to be kind of
investigators and people I think often always wonder
like, how do they figure that out, but it’s just because we know how things group together and how that
grouping could have implications for pregnancy prognosis.

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