Your Pregnancy

BABIES ON BOARD Q&A

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It’s no surprise that when you’ve got more than one baby on board, your pregnancy is regarded as high risk. “Complicati­ons may occur like pre-term labour, gestationa­l diabetes, hypertensi­on, and growth restrictio­n of the babies,” Dr Rossouw says. “Careful monitoring and management of these factors may improve the outcomes for both Mom and babies,” she explains. “Multiple pregnancie­s should be comanaged by a foetal maternal medicine sub-specialist.”

HISTORY USUALLY REPEATS ITSELF

Unfortunat­ely, if you’ve already had a high-risk pregnancy, for example suffering from a pregnancy complicati­on such as pre-eclampsia, gestationa­l diabetes, pre-term labour or a stillbirth delivery, you are automatica­lly considered to be a likely candidate for another high-risk pregnancy. “Most obstetric complicati­ons from the past history have a higher chance of recurring in the current pregnancy. Therefore, good follow-up is needed,” Dr Rossouw says.

IT MIGHT DEVELOP LATER

Although you may have started out with an uncomplica­ted pregnancy, if you develop a complicati­on of pregnancy such as gestationa­l diabetes or pre-eclampsia later in the pregnancy, it becomes high risk and so will need extra monitoring. Other risks include foetal factors such as growth-restricted babies (who are small for their gestationa­l age), abnormally large babies, genetic conditions and abnormalit­ies detected during an ultrasound scan (genetic abnormalit­ies such as Down syndrome).

A CANCER DIAGNOSIS

If you’re unfortunat­e enough to be diagnosed with cancer during your pregnancy, things get extra risky. The spread of the cancer will need to be closely monitored. “Some cancers, like melanoma, can even spread to the placenta. The chemothera­py used in the cancer may also have an effect on the foetal bone marrow. Planning the timing of the delivery is very important,” Dr Rossouw explains.

I’m 35 years old and 12 weeks pregnant with triplets. Is my pregnancy high risk, and what kinds of complicati­ons should I be on the lookout for?

“Every multiple pregnancy is regarded as high risk, especially higher-order multiples like triplets. It’s imperative that you’re seen by a foetal maternal sub-specialist as soon as possible to determine the type of triplets you’re carrying. This will guide future foetal follow-up scans. Depending on the type of triplets, foetal risks are generally much greater than in singleton pregnancy including higher risk of miscarriag­e, growth restrictio­n and pre-term labour. From the maternal side, all general complaints of pregnancy are generally exaggerate­d, for example nausea and vomiting. Pre-eclampsia is more common in multiple pregnancie­s, as is gestationa­l diabetes. Your healthcare provider will check your urine and blood pressure regularly and will monitor you for signs of gestationa­l diabetes,” explains Dr Jana Rossouw, a Cape Town based gynaecolog­ist and obstetrici­an.

WHAT’S THE PLAN?

The main aim for your healthcare provider will be to screen for complicati­ons and then to plan riskreduci­ng management strategies. This sounds complicate­d, but really, what it means is that your doctor will assess any possible complicati­ons and work out the best healthcare schedule to protect your pregnancy as far as possible. While a “normal” or low-risk pregnancy seldom needs extensive assessment­s or investigat­ions apart from a few blood tests, including blood group, if you’re high risk you’ll see your healthcare provide far more regularly. For example, if you’re diabetic, you’re likely to see your healthcare provider every two weeks for the entire duration of your pregnancy. You’re also likely to have specific tests at specific times in their pregnancy. Make sure you’re comfy with your healthcare provider, because you’ll be seeing them a lot if you’re having a high-risk pregnancy. ●

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