There are many specific examples of other types of high risk pregnancies. To write about all would be like attempting to write a huge textbook. I will limit myself to some of the common high risk pregnancies.
Older pregnant women
Older pregnant women are at higher risk of miscarriages, chromosomal abnormalities e.g. Down syndrome, and stillbirth at term.
Proper discussions of the strategies to detect chromosomal abnormalities (if parents desire) and stillbirth at term should be done.
Past history of bad obstetric history
These histories could include that of:
Proper discussions of the strategies to detect chromosomal abnormalities (if parents desire) and stillbirth at term should be done.
Past history of bad obstetric history
These histories could include that of:
- previous miscarriages
- previous spontaneous preterm labour
- previous indicated preterm delivery
- previous low birth weight baby (<2.5 kg) or intrauterine growth restriction
- previous pre-eclampsia
- previous stillbirth
- previous fetal abnormality - fetal abnormality may be due to chromosomal abnormality, structural abnormality, genetic syndrome, or infection.
Family history of abnormal development in children
These abnormalities could be due to chromosomal abnormality, structural abnormality, genetic syndrome, infection or birth injury. Further investigations may be required to delineate the cause before counselling of the risks that could be applicable to oneself.
Pre-existing medical conditions
These could include:
Pre-existing medical conditions
These could include:
- high blood pressure or hypertension
- high blood sugar level or diabetes mellitus
- high or low thyroid hormone levels
- antiphospholipid syndrome or one of the familial thrombophilias (e.g. protein S deficiency, protein C deficiency, antithrombin III deficiency)
- presence of anti-Ro or anti-La antibodies that may increase the risk of a heart block in the current pregnancy
- systemic lupus erythematosus
- others
Previous Caesarean section
The main risk occurs during labour.
The main risk occurs during labour.
The options of mode of delivery include:
- Elective Caesarean section (see risks of Caesarean section in the Mode of Delivery section)
- Vaginal Birth After Caesarean Section (VBAC). There are 3 possible outcomes for attempting this mode of delivery.
- Successful vaginal birth
- Failed vaginal birth resulting in emergency Caesarean section usually because of signs of fetal distress during labour or signs of poor progress during labour.
- Uterine rupture during labour which is rare, occurring in less than 1% of VBACs, but with potentially serious complications (e.g. death or brain damage of the baby, and hysterectomy / removal of the womb being necessary in some cases of uterine rupture). The percentages of successful vaginal birth / failed vaginal birth / uterine rupture in a VBAC may differ according to the different circumstances in each individual case.
A proper discussion with the obstetrician is required to decide on the mode of delivery.
