Shahid Akhter, editor, ETHealthworld spoke to Dr. Anita Soni, Consultant of Obstetrician & Gynaecologist at Dr. L H Hiranandani Hospital, Mumbai to know about the challenges associated with high risk pregnancies.
High-risk pregnancies : current scenario
Pregnancies have gone on from the times of Adam and Eve and will go on till thy kingdom come, but what makes it actually different today is our lifestyle and the complications caused by our lifestyles that are now affecting pregnancies in a larger perspective. Women were created to have babies ideally between the ages of 20 and 25, but today how many of the women actually get pregnant or married at this age? Most women are getting pregnant after the age of 30.
By then a lot of their ovarian volume or their oocytes or eggs are already haven’t gotten utilized in their best reproductive years without any result. By the time they plan a pregnancy, they’ve gone into their 30s and conceiving itself is becoming a problem. Approximately about 17-18% of our general OPD volume have got patients who have conceived after some kind of medical help, where conception itself has been difficult and they require Assisted Reproductive Technologies to get pregnant.
Medical disorders like diabetes, hypertension, polycystic ovaries, and renal disease have complicated pregnancies so much that what initially started off as a normal physiological change in a woman’s life, today has become a very big challenge for the hospital, the obstetrician and the patient herself.
A big volume of high-risk patients is generally referred to a tertiary care centre which has the infrastructure to support them. About 27-28% of our patients go in the high-risk category, whether they are already high risk the date they conceive or during the course of their pregnancy they develop complications and a normal pregnancy then gets converted into a high-risk category.
High-Risk pregnancies are pregnancies which have by themselves have been associated with Assisted Reproductive Technology to get pregnant. These women have had a pre-existing hormonal imbalance and hence require very strict monitoring during the pregnancy to prevent unnecessary pregnancy loss.
The second one is medical disorders like hypertension, diabetes, renal disease - all of these, in pregnancy, either developed or preexisting require a multidisciplinary team approach where a physician, an endocrinologist, a gynaecologist to be able to ensure an adequate or optimum result.
Approximately about 6-7% of patients in our OPD are presenting with more than two or three loses while they are planning their pregnancies. Nobody plans a pregnancy to lose it and when they’ve gone through it repetitively, twice, thrice maybe more, they definitely become high-risk pregnancies.
Challenges
Challenges are dealing with the patient, explaining about her own problems, explaining to the husband and the biggest challenge is explaining to the family. Doctors have to deal with the Indian myths which are associated with pregnancies, plus chart down diet, exercise, medications in such a way that the patient is confident about what she’s doing to land up with a healthy baby.
Outcomes
The outcomes are very dependant on what is happening through the pregnancy. Like we have a patient who is of 41 years old. Thirteen years ago, she had one normal delivery. This one was a spontaneous conception developed severe pregnancy-induced hypertension and today the blood flow from the mother to the baby has gotten stopped.
So there is absent flow to the baby. She is only 30 weeks pregnant with a 1.4-kilo baby. Now if you go there and you tell them that you may require a Caesarean section to deliver this baby, and medications to accelerate maturity because you cannot wait up to the normal 9th month in this woman because you’ll land up losing the baby, the family will all stand up and yell “no” saying “these are today’s doctors, they want to try and get the baby out early”. You have come with a problematic report. So if I don’t act on it, you will land up losing the pregnancy.
A lot of them can be crossed over with communication but there has to be two-way traffic where the understanding is good from even the family and the relatives where whatever the doctor is saying is for your benefit in terms of your diet, medications, and hospitalizations.
A proper tertiary care centre with an infrastructure that can support delivering these patients and a back up neonatal intensive care unit is also very important.
High-risk pregnancies at Dr. L H Hiranandani Hospital
For the high-risk pregnancies, we have got a completely certified lab for our blood test. We get our reports within an hour for emergency patients. We have an Intensive Care for the adult so in case the mother has excessive blood loss, high blood pressure, fits or eclampsia during pregnancy, you have the back up to put her into the Intensive Care. You have the physician, intensivist, and obstetrician all present at the same time.
Here we all sit together in the OPD, patient consults at a single payment and we present the entire case with the medical as well as the surgical management, the protocols, and the likely outcome, everything explained.
High-risk pregnancies : current scenario
Pregnancies have gone on from the times of Adam and Eve and will go on till thy kingdom come, but what makes it actually different today is our lifestyle and the complications caused by our lifestyles that are now affecting pregnancies in a larger perspective. Women were created to have babies ideally between the ages of 20 and 25, but today how many of the women actually get pregnant or married at this age? Most women are getting pregnant after the age of 30.
By then a lot of their ovarian volume or their oocytes or eggs are already haven’t gotten utilized in their best reproductive years without any result. By the time they plan a pregnancy, they’ve gone into their 30s and conceiving itself is becoming a problem. Approximately about 17-18% of our general OPD volume have got patients who have conceived after some kind of medical help, where conception itself has been difficult and they require Assisted Reproductive Technologies to get pregnant.
Medical disorders like diabetes, hypertension, polycystic ovaries, and renal disease have complicated pregnancies so much that what initially started off as a normal physiological change in a woman’s life, today has become a very big challenge for the hospital, the obstetrician and the patient herself.
A big volume of high-risk patients is generally referred to a tertiary care centre which has the infrastructure to support them. About 27-28% of our patients go in the high-risk category, whether they are already high risk the date they conceive or during the course of their pregnancy they develop complications and a normal pregnancy then gets converted into a high-risk category.
High-Risk pregnancies are pregnancies which have by themselves have been associated with Assisted Reproductive Technology to get pregnant. These women have had a pre-existing hormonal imbalance and hence require very strict monitoring during the pregnancy to prevent unnecessary pregnancy loss.
The second one is medical disorders like hypertension, diabetes, renal disease - all of these, in pregnancy, either developed or preexisting require a multidisciplinary team approach where a physician, an endocrinologist, a gynaecologist to be able to ensure an adequate or optimum result.
Approximately about 6-7% of patients in our OPD are presenting with more than two or three loses while they are planning their pregnancies. Nobody plans a pregnancy to lose it and when they’ve gone through it repetitively, twice, thrice maybe more, they definitely become high-risk pregnancies.
Challenges
Challenges are dealing with the patient, explaining about her own problems, explaining to the husband and the biggest challenge is explaining to the family. Doctors have to deal with the Indian myths which are associated with pregnancies, plus chart down diet, exercise, medications in such a way that the patient is confident about what she’s doing to land up with a healthy baby.
Outcomes
The outcomes are very dependant on what is happening through the pregnancy. Like we have a patient who is of 41 years old. Thirteen years ago, she had one normal delivery. This one was a spontaneous conception developed severe pregnancy-induced hypertension and today the blood flow from the mother to the baby has gotten stopped.
So there is absent flow to the baby. She is only 30 weeks pregnant with a 1.4-kilo baby. Now if you go there and you tell them that you may require a Caesarean section to deliver this baby, and medications to accelerate maturity because you cannot wait up to the normal 9th month in this woman because you’ll land up losing the baby, the family will all stand up and yell “no” saying “these are today’s doctors, they want to try and get the baby out early”. You have come with a problematic report. So if I don’t act on it, you will land up losing the pregnancy.
A lot of them can be crossed over with communication but there has to be two-way traffic where the understanding is good from even the family and the relatives where whatever the doctor is saying is for your benefit in terms of your diet, medications, and hospitalizations.
A proper tertiary care centre with an infrastructure that can support delivering these patients and a back up neonatal intensive care unit is also very important.
High-risk pregnancies at Dr. L H Hiranandani Hospital
For the high-risk pregnancies, we have got a completely certified lab for our blood test. We get our reports within an hour for emergency patients. We have an Intensive Care for the adult so in case the mother has excessive blood loss, high blood pressure, fits or eclampsia during pregnancy, you have the back up to put her into the Intensive Care. You have the physician, intensivist, and obstetrician all present at the same time.
Here we all sit together in the OPD, patient consults at a single payment and we present the entire case with the medical as well as the surgical management, the protocols, and the likely outcome, everything explained.
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