THE road to motherhood is a period filled with sweet memories for every woman.
But it can also be a time when mum and baby face certain challenges to their health and well-being.
High-risk pregnancies are those which require careful monitoring and management by a multidisciplinary team of medical professionals to ensure that the mother can successfully carry her baby to full term.
A pregnancy can be classified as high-risk at any stage. Women with pre-existing health conditions such as diabetes, chronic hypertension, or medical disorders like SLE, or renal failure, for example, may face complications during pregnancy, explains UM Specialist Centre consultant obstetrician and gynaecologist Professor Dr Vallikannu Narayanan.
However, the good news is that today, such pregnancies can have a positive outcome as long as the mothers are carefully monitored and managed by their doctors and adhere to medical advice.
"In the past, women with renal failure, for example, would be advised against getting pregnant, but today, we can even ensure a successful pregnancy in women on dialysis," says Dr Vallikannu.
While pre-existing conditions in the mother do pose additional risks, in some cases, an otherwise healthy woman may also develop certain conditions during pregnancy which puts her in the high-risk category.
Dr Vallikannu says the expectant mum may develop gestational diabetes, or high blood pressure, or face conditions such as pulmonary embolism, or deep venous thrombosis due to pregnancy hormones.
"Research indicates that one in four pregnant women in Malaysia are diabetic so their blood sugar needs to be very carefully monitored and steps taken to ensure it remains under control."
Placental problems can also come into play. In some women, the placenta may be low lying. In 70 per cent of cases, it will eventually move up, but in some women, it remains low, right on top of the cervix.
Such cases are referred to as major placenta previa and these women would need to undergo
caesarean section (C-section) to deliver their babies.
The water level around the baby in the uterus may also reduce, or increase during pregnancy, putting both mum and baby at risk.
The childbirth/delivery period can also turn risky for some women, even those with an otherwise healthy pregnancy, says Dr Vallikannu.
Some women with a difficult labour may require the assistance of instrumentation such as forceps, or vacuum to deliver their babies and if this fails, an emergency C-section may be necessary.
Some women with a difficult birth may also experience extended vaginal tearing, or heavy bleeding after delivery.
Post-delivery, there's the risk of infection in some mothers while others may be at high-risk for eclampsia. All this has to be managed to ensure the mother completes her pregnancy with her health and her baby's well-being intact.
IVF PREGNANCIES
With infertility on the rise and more couples opting for assisted reproduction methods to start their families, IVF pregnancies are on the increase in Malaysia.
IVF pregnancies are generally classified as high-risk because in most cases, the expectant mums would be older, having tried for years to conceive before turning to assisted reproduction, says UM Specialist Centre consultant obstetrician and gynaecologist Professor Dr Mukhri Hamdan.
Women opting for IVF would generally be screened for pre-existing medical conditions and a detailed medical history taken to ensure that doctors are well aware of any potential challenges to the pregnancy.
"Some medical conditions may worsen during pregnancy. For example, if the patient has heart disease, she could be doing well prior to the pregnancy, but during pregnancy, complications may arise so we need to refer her to a foetal maternal specialist."
If the mother is on certain medications for a health condition, that too needs to be addressed as some medicines may be harmful to the foetus.
Dr Mukhri says if the medication is deemed harmful, doctors may either opt for safer alternatives, or in some cases, the dose needs to be adjusted to ensure that it doesn't affect the well-being of the baby.
Certain diabetes and hypertension medications, for example, can be harmful during pregnancy.
Given that IVF may also result in twin or triplet pregnancies, it automatically doubles, or triples the risk for the mother.
"Such pregnancies have a higher risk of miscarriages and complications, and an increased risk of preterm delivery and premature infants."
Dr Mukhri adds that with IVF pregnancies, there's a higher risk of placenta previa, preterm delivery and babies born with low birth weight, so such pregnancies need to be carefully monitored.
Furthermore, research now indicates that women who opt for a frozen embryo transfer during IVF (as opposed to a fresh embryo transfer) have a higher risk of developing preeclampsia.
Nevertheless, with advancements in medicine and the involvement of a multidisciplinary medical team, women with high-risk pregnancies no longer need to face anxiety.
In the vast majority of cases, these women are able to deliver healthy babies and move on with positive memories of motherhood.
High Risk Pregnancy- Potential Causes
*Obesity
*Diabetes or hypertension
*Pre-existing genetic conditions
*Medical conditions such as heart disease, renal failure or cancer
*Advanced maternal age (over 35 years)
*Placental problems
* Foetus is too small or too large for gestational age