High-risk pregnancy? Very high-risk pregnancy? What do these terms mean?

The correct medical terminology is ‘high-risk pregnancy’, which involves a large number of different medical conditions. The one thing these conditions have in common is that they cause the pregnancy to be different, non-routine, and require close monitoring with more frequent follow-ups than other pregnancies.

What type of doctor manages high-risk pregnancies?

A doctor who specializes in high-risk pregnancies is a gynaecologist who has completed a subspecialty or additional training in the management and treatment of such complex cases. High-risk pregnancies require extra care for both the mother and fetus, as both are at increased risk throughout the pregnancy.

Who determines the criteria for a high-risk pregnancy, and what medical conditions make a pregnancy high-risk?

These criteria are typically set by local or national guidelines, and are based on current definitions that are found in medical literature.
As you will read below, these definitions have many implications, including financial consequences. In most medical settings, high-risk pregnancies are those in which there is a concern for one of the following conditions in the following paragraphs.

What are the different conditions that meet the criteria for a high-risk pregnancy?

Maternal age

Pregnant women under the age of 17 or over the age of 40 are considered to have high-risk pregnancies.

Significant medical history prior to pregnancy

High-risk clinics are visited by pregnant women who have medical conditions that can affect the pregnancy, the health of the pregnant mother, or the development of the fetus. Therefore, it is important to seek consultation before pregnancy.
Examples of such conditions include hypertension, diabetes, hyper-coagulability, autoimmune disease, pre-gestational diabetes, inflammatory bowel disease, asthma, epilepsy, morbid obesity (BMI above 30), extreme underweight (BMI under 18), and more.
Controlling these conditions prior to the pregnancy generally leads to better outcomes during the pregnancy.

Past obstetrical or gynecological history

Women who have experienced complications during their previous pregnancies fall into this category. For example, a history of early delivery, eclampsia, gestational diabetes, previous small-for-gestational-age baby, prior cesarean section, and more.
Sometimes, interventions can be implemented to prevent such complications from occurring and to identify them as soon as they begin to develop.

Present medical illnesses

High-risk clinics are visited by pregnant women who either have conditions that are developed during the pregnancy or by women who have complicated pregnancies that are considered high-risk to begin with. For example, these include a multiple pregnancy, short cervix, early labor, eclampsia, gestational diabetes, viral infections during pregnancy such as CMV, and more. To learn more about CMV infections during pregnancy follow the link here.

What does a follow-up at the high-risk unit include?

High-risk clinics offer consultation before pregnancy as well as close follow-up and care throughout the pregnancy. These follow-ups are important and may be critical for both the health of the mother and baby. The frequency of visits and the tests required vary depending on the mother, her medical history, the conditions she has, and the pregnancy itself. Emphasis is placed on the tests advised such as Amniocentesis, Focused Ultrasound scans or third anatomical scans, which are becoming more and more popular these days, and more.

What are the financial implications of high-risk pregnancies?

High-risk pregnancies require closer monitoring and therefore, prices of different tests may vary depending on your national health system.

Where can high-risk pregnancies be followed up?

This may vary in different countries around the world. However, high-risk pregnancies are usually followed up either in outpatient clinics, public hospitals, or private healthcare clinics/hospitals.

Should all pregnancies be considered high-risk?

All pregnancies are precious. Most pregnancies are normal, and routine follow-ups are sufficient. However, when a pregnancy meets one of the criteria mentioned above, it is best to refer to a specialist for further care.

It is important to remember that most high-risk pregnancies have good outcomes and result in healthy babies when closely monitored and cared for. Therefore, I find it important to remain optimistic and think positive during the pregnancy.

In summary, I hope your pregnancy is as smoothly as possible. Should any questions arise, or should the pregnancy fall into one of the categories mentioned above and become a high-risk pregnancy, I advise you to consult with an experienced specialist. Remember, this is for the sake of your own health and your child’s.