High-Risk Pregnancy

Fortunately, very few women face the potential of having a high-risk pregnancy. For most families, having a baby is quite natural: Conception occurs spontaneously; the baby grows normally; labor occurs on its own near the mother's due date; and after a routine delivery, both mother and baby go home without incident. Still, not all pregnancies go so smoothly. The patients we work with in the Division of Maternal-Fetal Medicine tend to fall into three major groups:

 

Women Who Have Medical Problems before Becoming Pregnant

These women usually know from the start that their pregnancies will need additional, special attention. Most commonly, these are women with high blood pressure or diabetes. We also see many women with lupus or other autoimmune diseases and thyroid problems. Chronic infectious problems like HIV infection and hepatitis are also managed with specialized attention.

Pre-pregnancy planning is especially important for a woman with pre-existing medical conditions. Her physician can help her achieve the best possible health before she conceives.

The physician may adjust the patient's medications, as well. Some drugs may not be recommended for use during pregnancy, but many are perfectly fine to continue during pregnancy. Automatically discontinuing prescribed medication after a positive pregnancy test can put the women and the pregnancy at even higher risk.

Our Maternal-Fetal Medicine doctors are specially trained to work with pre-existing medical problems. They can help determine what is and is not safe for pregnancy and what to expect from specific conditions. Working closely with the patient's primary care physician, our specialists develop a detailed plan of care for the pregnancy.

Women Who Develop Medical Problems during Pregnancy

On occasion, otherwise healthy women develop serious medical problems during pregnancy. Sometimes these are problems that are specific to the pregnancy. In other cases, they are problems diagnosed during the pregnancy.

High blood pressure and diabetes (high blood sugar) that are limited to pregnancy are the most common problems. At Cedars-Sinai, we have specific programs to best manage both conditions, which appear to be related to how an individual's body responds to the chemicals produced by the placenta or the fetus during pregnancy. The risk for these problems tends to run in the mother's side of the family (mothers, sisters, maternal aunts). While we cannot yet prevent these problems, we can screen women to identify them early and manage them during pregnancy.

Our doctors and nurses explain these conditions and their risks to both the mother and her primary care physician. The fetus can also be affected by these problems. Our outpatient monitoring programs can assure fetal well-being with ultrasounds and additional noninvasive tests. For high blood pressure, we can coordinate home blood pressure monitoring and guide the right medical therapy, if needed. For gestational diabetes, our certified diabetic nurse-educator instructs patients in appropriate diet. If necessary, our doctors will help manage her sugars more intensively.

Women with Problems Related to Pregnancy

During a pregnancy, problems sometimes arise that are specific to the pregnancy itself and have little to do with the mother's medical status.

Premature labor is a relatively common pregnancy problem. About 5 to 8% of all babies in the United States arrive in less than 37 weeks. Women who have had previous premature babies are at higher risk. Our doctors have specific expertise and published research in this difficult area of obstetrics.

Twins or higher-order multiple pregnancies are more common today as more women use infertility treatments. This increases the risks of premature labor, gestational diabetes and pregnancy-induced high blood pressure.

Placenta previa is a condition in which the placenta (afterbirth) covers the cervix. It can cause bleeding, especially if a woman has contractions. If the placenta still covers the cervix close to delivery, a cesarean section will be done to reduce bleeding risks to the woman and the baby.

Fetal problems are sometimes seen on an ultrasound. Approximately 2 to 3% of all babies have a minor or major structural problem in development. Many can be seen with an ultrasound. A maternal or family history may signal that a pregnancy is more likely to have unusual developmental problems. Many problems, however, are completely unexpected.

Our Maternal-Fetal Medicine staff is highly trained in the use of leading-edge ultrasound procedures to assess the well-being of the baby before birth. High-resolution ultrasound is used to evaluate the baby's health. Fetal echocardiography examines the heart's function. Three-dimensional ultrasound allows doctors to construct a full picture of the face, limbs and heart. Scans can measure bloodflow to critical parts of the developing brain.

Genetic problems in pregnancy are most commonly related to the mother's age. Women older than 35 are at higher risk of having babies with Down syndrome (trisomy 21) and other chromosome abnormalities. Still, not all affected pregnancies are seen in older mothers.

At Cedars-Sinai, we are developing better screening tests for those at risk for genetic problems. Tests include combinations of newly developed maternal blood tests and skin thickness measurements of the early developing embryo. We offer a full range of genetic testing procedures, including second-trimester amniocentesis and first-trimester chorionic villus sampling (CVS).

Our Prenatal Diagnostic Center performs more CVS procedures than any other facility on the West Coast, and it is among the five most experienced centers for this procedure in the country. This expertise is important because studies have shown that experience with this procedure is associated with fewer complications.

We know that potential complications can be daunting, but our Division of Maternal-Fetal Medicine has experience managing all of these problems. Our doctors are often asked to balance risks, explain options and map out manageable plans. The goal is always to get the best outcome for both mother and baby.

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