BABIES ON BOARD Q&A
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. ●