Which prenatal client has the greatest risk of delivering a baby with a defect?
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From Mayo Clinic to your inboxSign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. ErrorEmail field is required ErrorInclude a valid email address Learn more about Mayo Clinic’s use of data.To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Most of the time having a baby is a natural process. After a full-term pregnancy, women go into labor on or near their due date and give birth to a healthy baby. A day or two later they leave the hospital to begin day-to-day life with their growing family. But not all pregnancies go smoothly. Some women experience what doctors refer to as a high-risk pregnancy. A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. High-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby. Risk Factors for High-Risk PregnancyReasons that a pregnancy may be considered high risk include: Maternal age. One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40. Medical conditions that exist before pregnancy. Conditions that can pose risks to the mother or baby include:
A history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are also risk factors for a high-risk pregnancy. If you have a medical condition, it's important to consult your doctor before you decide to become pregnant. Your doctor may run tests, adjust medications, or advise you of things you need to do to protect the health of you and your baby. Medical conditions that occur during pregnancy. Even if you are healthy when you become pregnant, it is possible to develop or be diagnosed with problems during pregnancy that can affect you and your baby. Three of the more common pregnancy-related problems are:
Pregnancy-related issues. Often a pregnancy is classified as high risk because of issues that arise from the pregnancy itself and that have little to do with the mother's health. These include: A biophysical profile (BPP) may be scheduled for women whose pregnancies are considered high-risk. This is a test that checks fetal health. It combines a nonstress test (NST) with an ultrasound exam, and it's usually done after the 28th week of pregnancy. An NST is usually done to evaluate the health of the fetus. It involves placement of a fetal monitor on the mother's abdomen and interpretation of the fetal heart rate in response to fetal movements. It generally takes 20 to 30 minutes, and you don’t need to stay overnight in the hospital. Interpretation of the nonstress test can sometimes be misleading; there is a relatively high rate of false-positive results, which means the test may come back positive when the fetus is actually well. It's hard to decide what to do next. The BPP makes that less likely by combining the nonstress test with an ultrasound exam. It also takes 30 minutes and can be done on an outpatient basis. The ultrasound exam checks four things: Each of these, plus the nonstress test, gets a score from 0 to 2. The scores are added up for a maximum of 10. The interpretation of the BPP score depends on the clinical situation. In general, a score of 8 or 10 is considered normal, but a score below 8 usually requires further evaluation or delivery of the baby. What a Biophysical Profile Shows Normal (Score=2) Abnormal (Score=0) Nonstress test ReactiveNonreactiveFetal tone 1 or more extensions of arm/leg or trunk with return to flexion; opening and closing of handNo extension/flexion noted in 30 minutesFetal breathing movements 1 or more lasting at least 30 seconds within a 30-minute intervalNone in 30 minutesGross body movements 3 or more discrete body/limb movements in 30 minutesLess than 3 in 30 minutesAmniotic fluid volume At least one pocket of amniotic fluid 2 cm or moreNo amniotic fluid pocketsof 2 cm or moreYour doctor will decide which test is best for your situation. They may do a BPP if you have:
Preventing and Treating Pregnancy ComplicationsEven if you don't have an existing health problem, many doctors recommend a preconception appointment with your health care provider to ensure you are as healthy as you can be before you become pregnant. At this appointment your doctor may recommend steps you can take to reduce the risk of certain problems. These include:
If your pregnancy is considered high risk, your doctor may refer you to a perinatologist. Also called a maternal-fetal medicine specialist, a perinatologist is an obstetrician with special training in high-risk pregnancy care. This specialist will work with your other doctors, nurses, and other health care professionals to ensure the best possible outcome for both you and your baby. SOURCES: University of California, San Francisco Medical Center: "High-Risk Pregnancy." The University of Pennsylvania Penn Medicine: "Maternal Fetal Medicine (High-risk Pregnancy)." National Institute of Child Health and Human Development: "High-Risk Pregnancy,” “Preterm Labor and Birth,” "What is a High Risk Pregnancy?" "Who Is at Risk for Preterm Labor and Birth?" Drexel University College of Medicine: "High-Risk Pregnancy." University of Maryland Medical Center: "Later Age Pregnancy." Cedars-Sinai Health System: "High-Risk Pregnancy." American Congress of Obstetricians and Gynecologists: “Frequently Asked Questions: Gestational Diabetes,” “Frequently Asked Questions: High Blood Pressure During Pregnancy,” “Frequently Asked Questions: Preterm Labor,” “Frequently Asked Questions: Later Childbearing,” “Frequently Asked Questions: Good Health Before Pregnancy: Preconceptional Care,” “Frequently Asked Questions: HIV and Pregnancy,” "Obesity in Pregnancy," “Perinatal and Postpartum Depression a Top Priority.” Callaghan W. Obstetrics & Gynecology, November 2003. CDC: "Pregnancy and Prenatal Care," "Pregnancy Complications." Kaiser Permanente Research & Evaluation: “Overweight and Obese Women more Likely to Have Large Babies.” KidsHealth from Nemours: “Preparing for Multiple Births.” International Journal of Epidemiology: “Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses.” Lovina, S. North American Journal of Medical Sciences, January 2012. March of Dimes: “Overweight and Obesity During Pregnancy.” National Institute of Diabetes and Digestive and Kidney Diseases: "What I Need to Know about Gestational Diabetes." National Organization of Mothers of Twins Clubs Inc.: “Long Term Effects of Pre-Term Multiple-Birth.” Which patients would be at highest risk for pregnancy related complications?Preeclampsia or eclampsia. A woman carrying multiple fetuses.. A teenage mother.. A woman older than 40.. A woman with high blood pressure, diabetes, and/or kidney disease before she became pregnant.. A woman who is obese with a BMI greater than 30.. What are some of the greatest prenatal risks to the developing fetus?Fetal risk factors include:. Birth defects, such as congenital heart defects.. Chromosome problems, such as Down syndrome.. Genetic syndromes, such as Fragile X syndrome.. Inherited diseases, such as cystic fibrosis.. Fetal growth restriction: The fetus grows more slowly than normal.. Which prenatal stage is the most vulnerable?In general, major defects of the body and internal organs are more likely to occur between 3 to 12 embryo / fetal weeks. This is the same as 5 to 14 gestational weeks (weeks since the first day of your last period). This is also referred to as the first trimester.
What factors increase risk for complications during delivery?Other factors that may increase your risk for complications include:. being pregnant at age 35 or older.. being pregnant at a young age.. having an eating disorder like anorexia.. smoking cigarettes.. using illegal drugs.. drinking alcohol.. having a history of pregnancy loss or preterm birth.. |
