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Home , Obstetrics, Pregnancy

High-risk and high-risk

Having a baby is one of life’s most exciting Who is likely to have a high-risk experiences, but there are many things pregnancy? to learn when planning for . Good and medical treatment You are at risk if you: during pregnancy can help prevent • Smoke. complications. No matter how healthy • Are , especially 50 pounds or you are, pregnancy can be unpredictable. more. Plan for the unexpected now to help ensure your transition from pregnancy to • Have high pressure. motherhood is a smooth one. • Have . • Have . What is the difference between a • Use drugs. • Drink alcohol. high-risk pregnancy and high-risk • Have a family history of genetic defects. obstetrics? • Are expecting multiples (, triplets). • High-risk pregnancy refers to a • Are over age 35 or younger than 18. pregnancy during which a condition puts the , developing or • Have previous health issues including both at a higher-than-normal risk for , organ transplant, sexually complications. transmitted or weight loss . • High-risk obstetrics refers to complications during the delivery • Have had any complications in previous process, including premature labor. such as pre-, or preterm labor It is important to remember it is possible and/or delivery. for a high-risk pregnancy to have no difficulties during the actual delivery, just Having any one or more of these risk as it is possible for a high-risk delivery to factors does not guarantee a high-risk occur with a low-risk pregnancy. pregnancy or delivery. Similarly, not having a risk factor does not guarantee a low-risk • First trimester screening – At 11-13 weeks, the pregnancy or delivery. pregnancy is evaluated with an and blood work. Preconception counseling • – At 15-20 weeks, a small sample One of the most beneficial pregnancy- of , the fluid that surrounds the planning activities for a is to consider baby, is collected and tested. preconception counseling with an OB/GYN or • Quad screen – Between 16 and 18 weeks, blood maternal-fetal . is drawn and tested. The doctor will take a very careful history of the If any of these tests indicate that you may be a mother and her family and the baby’s father and high-risk patient, your obstetrician will refer you his family before pregnancy to determine any to a high-risk program. factors, illnesses or conditions that may affect the mother or the fetus, such as a genetic defect or Why are high-risk obstetrics programs history of preterm deliveries. necessary? By understanding their health and possible risk factors, couples have the advantage of deciding A high-risk obstetrics program is prepared to whether and when to start a family. handle difficult situations, whether they are predicted or arise during the delivery. Because If you have an underlying medical condition, you high-risk pregnancies and deliveries involve more should ask your doctor: than a single life, it is important to have a program • What effect could my medical condition have on for the specialized care of both mother and . the pregnancy and baby? High-risk care means having 24-hour access • How will pregnancy affect my long-term health? to an entire team of doctors, nurses and A woman’s health prior to conception and during anesthesiologists, as well as a blood bank, pregnancy is one very important influence on the neonatal intensive care unit (NICU) and surgical outcome of pregnancy. It is important for women intensive care unit dedicated to the care of to keep any pre-existing medical conditions under women and their babies. control leading up to and during pregnancy. What should you look for in a high-risk Prenatal genetic testing obstetrics program? Many families have a history of genetic . • specializing in maternal-fetal These families may desire further information medicine about how this condition could affect pregnancy • Ultrasound unit and the baby. Genetic testing may also be offered • Nutritionists to couples without a family history of genetic • Pediatric surgeons and cardiologists disease who have other risk factors. Discussion • Neonatologists of prenatal genetic testing should begin with your obstetrician. • Geneticists Several tests can be done before pregnancy to You should choose a program that has the ability determine the potential of a fetus having a genetic to cope with your specific health needs and any disorder, such as , health issues your baby may face at birth. If you or a neural tube disorder. Tests can also be done have complications during delivery, it is important during pregnancy to detect these disorders. to be in a that has a NICU with the highest level of trained specialists. Options include: NICUs are classified into three levels. Level I • Chorionic villus sampling (CVS) – Between 10 NICUs are capable of offering continued care and 12 weeks, a sample of tissue is taken from for low-birth-weight babies born prior to 35-36 the and tested. weeks maturity who are not ill but require are cared for in the same building, so neither frequent feeding or more hours of baby nor mom has to endure the stress of being than a normal newborn. Babies born transferred after birth. before a pregnancy has reached 32 weeks who need 6-12 hours of nursing per day What should you expect with a high- are cared for in Level II NICUs. A Level III NICU is an intensive care unit for babies risk obstetrics program? born extremely premature and requiring • More visits to the doctor. continuous cardiopulmonary and other • Increased monitoring of baby’s health. support and constant nursing care, as well • Diagnostic testing, if appropriate. as those requiring less-intensive care. • Possible hospitalization during pregnancy. Kentucky Children’s Hospital has the only • Frequent . Level III NICU in the Bluegrass area. • Possible visits to other specialized doctors At UK HealthCare, and babies depending on your condition.

Tips from high-risk patients anything you might need in case you go into who have dealt with the stress of labor. Bring a friend who can help if there is high-risk pregnancies and obstetrics can a problem. offer unique insight into the obstacles • Compile a list with contact information for others will face and how to cope. Here are support services such as -cleaning their suggestions: services, babysitters and .

For all pregnant women For pregnant women on bedrest and/or having • If you have small children at home, make multiple babies arrangements in case you have • You may require assistance with cooking, an urgent need to go to the hospital. cleaning and child care. • Prepare for any transportation issues that • Some women experience social isolation may arise before or after the baby arrives. when on . Find appropriate ways to • Prepare family and your employer for the continue participating in social events. possibility of a cesarean birth. Schedule • Find appropriate ways to continue spending help at home for the first three weeks quality time with your other children. Some after discharge. children act out when this time together is • If you live or work in an area far from cut short. your hospital, make sure you check out • Expect a longer recovery time due to loss of which hospital you need to go to in an after prolonged bed rest. emergency. Some are better equipped to handle preterm labor. Postdelivery • Have a list of emergency contact phone • Many cities have clubs for mothers of numbers available in several places. In multiples. Join one, as these mothers will your cellphone, change the name of your understand and be able to offer tips for emergency contact to the acronym ICE managing the stress of raising multiple (In Case of Emergency). and children. • Ask your doctor if it is safe to travel. • Depression is a common byproduct of a If you are driving out of town, take high-risk pregnancy or delivery – don’t be a cellphone and overnight bag with afraid to seek help. UK HeathCare resources e-News is a free weekly email newsletter that focuses on each week of Childbirth education classes are a woman’s pregnancy and discusses the offered at UK HealthCare. Learn more development of the baby and the mother’s by visiting ukhealthcare.uky.edu/ experience. Visit ukhealthcare.uky.edu/ womenshealth/childbirthed.asp. newsletter to subscribe. support services are available to new mothers. Learn more at Additional resources ukhealthcare.uky.edu/womenshealth/ Ronald McDonald House offers local breastfeeding.asp. lodging for families with seriously ill The Mommy & Me Breastfeeding children. Visit www.rmhclexington.com is available to all moms who for more information. would like to breastfeed and are helps moms have full- interested in having a breastfeeding term pregnancies and researches the assessment performed by a Kentucky problems that threaten the health of babies. Children’s Hospital physician and/or Learn more at www.marchofdimes.com. consultant. The physician and will work with the The American Diabetes Association mother to develop a plan that meets works to to prevent and cure diabetes and the mother’s goals, answer questions, to improve the lives of all people affected suggest resources and assist with any by diabetes through research, services, problems. For an appointment, please information and advocacy. Information is call 859-323-6211. available at www.diabetes.org. UK Women’s Health Obstetrics & Gynecology specializes in providing medical care and treatment of the female . This clinic offers a variety of primary and care and accepts referrals of all types. Specialties include high-risk pregnancies, the reproductive system, treatment of gynecologic malignancies, and a range of difficult gynecologic problems. Visit ukhealthcare.uky.edu/ womenshealth/obgyn.asp for additional information.

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Call UK Health Connection at 859-257-1000 or toll free 1-800-333-8874 to make an appointment or request a referral. Visit us online at ukhealthcare.uky.edu.