High Risk Pregnancy

High Risk Pregnancy

Care of CIMS maternal-foetal medicine specialist extends from preconception care to specialized prenatal care and intrapartum care, obstetric and medical complications of pregnancy, diagnosis and management of foetal anomalies, foetal complications and foetal testing.

A high risk pregnancy is one in which some condition puts the mother, the developing fetus, or both at higher-than-normal risk for complications during or after the pregnancy and birth.

We manage the full-spectrum of high-risk pregnancies, giving comprehensive care. Our expert specialists have extensive experience in the management of the most complex maternal and foetal disorders. A pregnancy is also considered high-risk when prenatal tests indicate that the baby has a serious health problem (for example, a heart defect). In such cases, the mother will need special tests, and possibly medication, to carry the baby safely through to delivery.

Care provided by our maternal-foetal medicine subspecialists as well as other obstetric care providers:

A.PRECONCEPTION CARE

Preconception evaluation of women to optimize maternal and perinatal outcomes. Examples include women with underlying illness, previous adverse pregnancy outcome, or considering advanced reproductive technology.

B.SPECIALIZED PRENATAL CARE

  • Evaluation of pregnant women needing counseling regarding prenatal care issues, and nutrition
  • Ultrasound – standard, limited and specialized (e.g. detailed sonography, foetal echocardiogram, Doppler studies)
  • Prenatal diagnosis, aneuploidy screening and foetal therapy (CVS, amniocentesis, foetal blood sampling and transfusion, foetal thoracocentesis and thoracoamniotic shunt placement, foetal vesicocentesis and vesicoamniotic shunt placement, laser, foetal surgery)
  • Genetic screening for women at increased risk for genetic disorders

C.LABOUR AND DELIVERY AND ASSOCIATE COMPLICATIONS

Any antepartum patient admitted for “other than delivery” support for intrapartum care including before labor; first-, second- and third-stage issues; intrapartum foetal monitoring; aneasthesia and analgesia; operative vaginal delivery, cesarean delivery; trial of labor after cesarean

D.OBSTETRIC COMPLICATIONS

  • Recurrent pregnancy loss
  • Preterm birth prevention
  • Asymptomatic (e.g. prior second trimester loss, possible cervical insufficiency; prior PTB; Mullerian abnormalities; short cervical length; issues related to cerclage, pessary, progesterone, or other interventions for prevention of PTB
  • Symptomatic (PTL or PPROM) <34 weeks gestation
  • Meconium complications
  • Malpresentation and malposition
  • Shoulder dystocia
  • Abnormal third stage of labor
  • Placenta accreta, increta, percreta
  • Second- or third-trimester vaginal bleeding
  • Preeclampsia with severe elements/eclampsia with HELLP syndrome (a life-threatening pregnancy complication usually considered to be a variant of preeclampsia) or end-organ damage
  • Severe postpartum hemorrhage
  • Cesarean hysterectomy
  • Acute fatty liver of pregnancy
  • Amniotic fluid embolism

E.MATERNAL COMPLICATIONS

  • Hypertensive Disorders
  • Cardiac Disease
  • Congenital heart disease
  • Arrhythmias
  • Valve disease
  • Cardiomyopathy
  • Pulmonary hypertension
  • Coronary artery disease
  • Heart transplant
  • Respiratory Disease
  • Asthma
  • Pneumonia
  • Restrictive lung disease
  • Pulmonary edema
  • Influenza
  • Tuberculosis
  • Cystic fibrosis
  • Obesity
  • Endocrinologic Disorders
  • Addison disease
  • Diabetes, insulin-requiring/ dependent
  • Thyroid disease
  • Parathyroid disease
  • Pheochromocytoma
  • Gastrointestinal Disease
  • Nausea and vomiting in pregnancy; Hyperemesis gravidarum
  • Eating disorders
  • Intrahepatic cholestasis
  • Inflammatory bowel disease (ulcerative colitis; Crohn’s disease)
  • Gallbladder disease (cholecystitis, cholelithiasis)
  • Pregnancy after liver transplantation
  • Pancreatitis
  • Wilson’s disease
  • Hematologic Diseases
  • Maternal anemia and hemoglobinopathies
  • Sickle cell disease
  • Von Willebrand disease
  • Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome
  • Care of the Jehovah’s Witness pregnant woman
  • Renal Disease (includes renal transplantation)
  • Neurologic Diseases
  • Seizure disorders
  • Headache
  • AV malformation/ berry aneurysm
  • Multiple sclerosis
  • Pseudotumor cerebri
  • Myasthenia gravis
  • Spinal cord injury
  • Diabetes insipidus
  • Psychosocial Issues and Abuse
  • Smoking
  • Alcohol abuse
  • Drug abuse
  • Depression
  • Other psychiatric disorders
  • Domestic violence
  • Rheumatologic Disorders
  • Antiphospholipid syndrome
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Other autoimmune disease
  • Thromboembolic Disorders
  • Venous thromboembolism and anticoagulation
  • Inherited thrombophilia
  • Infectious Disorders
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • HIV
  • Gonorrhea
  • Chlamydia
  • Syphilis
  • Trichomonas
  • Group B streptococcus
  • Vaccination concerns
  • Pyelonephritis
  • Management of wound infection
  • Trauma and Critical Care
  • Trauma
  • Critical care
  • Skeletal; Connective Tissue
  • Marfan syndrome
  • Maternal skeletal dysplasia
  • Dermatoses
  • Cancer before and during pregnancy
  • Non-obstetric abdominal surgery in the current pregnancy

F.FOETAL ANOMALIES

  • Structural abnormalities
  • Family history of abnormality
  • Aneuploidy or increased risk for aneuploidy
  • Teratogen exposure

G.FOETAL COMPLICATIONS

  • Threatened miscarriage (including medical and surgical management)
  • Multifoetal pregnancies (including, but not limited to, mono/di twins, mono/mono twins, higher-order multiples; foetal growth restriction of 1 fetus; twin-twin transfusion syndrome; foetal reduction)
  • Growth disorders
  • Growth restriction
  • Macrosomia
  • Infections (e.g., Cytomegalovirus, toxoplasmosis, parvovirus, Herpes, varicella)
  • Foetal death
  • Hemolytic disease (Red cell alloimmunization)
  • Neonatal alloimmune thrombocytopenia
  • Non-immune hydrops

H.FOETAL TESTING

  • Antepartum foetal monitoring
  • Sonographic assessment of amniotic fluid abnormalities
  • Oligohydramnios
  • Hydramnios
  • Foetal blood sampling/intrauterine transfusion
  • Screening for foetal anemia
  • Foetal muscle/organ biopsy
  • Foetal skin sampling
  • Foetal surgery; foetoscopy/ embryoscopy

I.GYNAECOLOGIC ISSUES RELATED TO PREGNANCY AND THEIR IMPACT ON PREGNANCY

  • History of infertility
  • The adnexal mass

J.POSTPARTUM CARE
Postpartum care, breastfeeding, contraception, and complications such as severe hemorrhage, refractory infections, complicated preeclampsia, eclampsia and difficult post cesarean complications