Pregnancy is a period of intense physical, hormonal and emotional transformations in the woman’s body. During these nine months, the body adapts to ensure the healthy development of the baby, requiring constant health care. Even with proper medical follow -up and all recommended precautions, some women may face complications that characterize so -called high -risk pregnancy.

“A pregnancy is considered at high risk when there are pre-existing or developed medical conditions/diseases during pregnancy that increase the risk of complications for the mother and/or the fetus during pregnancy, childbirth and/or postpartum. These conditions include chronic maternal diseases, unfavorable obstetric history or factors related to current pregnancy,” Elton Ferreira, coordinating prenatal coordinator of the high-risk prenatal coordinating Vera Cruz Hospital, in Campinas (SP).

Most common causes of high -risk pregnancy

According to the Ministry of Health (MS), about 15% of pregnancies are considered high risk in Brazil. The most frequent causes are:

• Gestational diabetes;
• Hypertension (high blood pressure);
• Diseases of thyroid and other autoimmunes;
• Pregnancy after 35, or before the age of 19;
• Multiple pregnancy (moans, trigemelars etc.);
• Post IVF (in vitro fertilization) pregnancies
• Premature birth or gestational loss in previous pregnancies;
• Inadequate fetal growth.

“It is important to clarify that, most of the time, high -risk pregnancies will evolve well. In order to have a greater chance of happening, it is essential that these pregnant women are accompanied by a specialized professional and qualified in the care of high complexity pregnancies and that there is a multidisciplinary involvement in this care,” says Elton Ferreira.

Responses on high -risk pregnancy

Next, Elton Ferreira answers 10 important questions about high -risk pregnancy. Check it out!

1. How is high -risk pregnancy diagnosed?

Early recognition of a pregnancy with possible complications involves a detailed analysis already in the first consultations. “[A gestação de alto risco] It should be diagnosed during routine prenatal consultations. In the first, it is essential to evaluate the medical history to identify pre-existing conditions that may affect pregnancy, such as chronic diseases, complications in previous pregnancies, family history, antecedent of surgeries, use of medications and assisted reproduction techniques. It is important to note that this evaluation should be integral and continued throughout the prenatal care, ”says the obstetrician.

2. For patients trying to get pregnant, a preconception is important?

Yes, seeking medical advice before conception can contribute to a gestation safer and most well-planned. “[…] In this consultation, before attempts to get pregnant, we can clarify doubts, start supplementation of folic acid, control existing diseases and guide the replacement of medications that may use and should not be used in pregnancy, ”lists the professional.

According to Elton Ferreira, in cases of greater vulnerability, professional follow -up tends to be more frequent to ensure rapid responses to any change. “[A frequência das consultas] should be individualized according to the condition presented. Generally, consultations are more frequent when compared to that observed in attending prenatal care of usual risk. This allows strict continuous monitoring and timely intervention in case of complications. ”

4. How is the baby’s well-being monitoring in high-risk pregnancy?

There are varied methods that help in the control of fetal health, both in consultations and in the daily life of the pregnant woman. “There are several strategies for analyzing the well-being of the baby. This encompasses since the evaluation of the size of the baby (uterine height), the baby’s heart movements and beats, and the health of the mother in prenatal consultation, as well as the control of fetal movements by the pregnant woman at home, the performing of cardiotocography and ultrasound,” explains the coordinator of the high-risk high risk prenatal Cross.

5. In cases of high risk pregnancy, what is the strategy for determining the safest moment for delivery?

The definition of the best period for birth is based on multiple criteria that vary according to each clinical situation. “[O parto] It is also something individualized and should take into account the disease presented, whether or not it is controlled, gestational age, as well as being based on a balance between the risks of continuing pregnancy and the risks of prematurity. It is very important that all conduct has scientific basis and is widely discussed, enlightened and shared with the pregnant woman and eventual partner ”, explains the obstetrician.

6. What is preeclampsia?

Preeclampsia is a disease that deserves attention. “[A pré-eclâmpsia] It is the elevation of blood pressure, usually after 20 weeks of pregnancy, associated with the involvement of one or more organs/systems, such as kidneys, brain, liver, lung, heart and/or hematopoietic system (blood). It is a frequent and dangerous disease and therefore needs a careful and attentive prenatal care, ”says the expert.

He also points out that “all patients diagnosed with blood pressure raising in pregnancy, whether chronic arterial hypertension, gestational hypertension or preeclampsia, should be immediately referred to a specialized reference service.”

7. Are there strategies to prevent preeclampsia?

Yes, preventive measures can be adopted, especially among women with greater risk for the development of the board. “For pregnant women who have risk factors for the development of this disease, we can start some medications and supplements at the beginning of prenatal care (from 12 weeks), such as acetylsalicylic acid (AAS) and calcium. The use of these substances, however, reduces the risk of preeclampsia, but does not eliminate. In addition, to those that do not have contraindications, the regular activity also decreases. The risk of pathology, ”explains Elton Ferreira.

8. Which risk factors indicate the use of preventive medications for preeclampsia?

The indication of these medications occurs when there is a high risk factor or two medium risk factors present, such as:

• High risk: Chronic arterial hypertension, preeclampsia/hypertension In anterior pregnancy, type 1 or type 2 diabetes, obesity, twin pregnancy, chronic kidney disease, autoimmune diseases such as antiphospholipid syndrome and systemic lupus erythematosus, and post-FIV gestation (in vitro fertilization);
• Moderate risk: First pregnancy, age older than 35 years, family history of preeclampsia (mother and/or sister), gestation range over 10 years, among others.

9. In the case of gestational diabetes, what precautions should be taken?

Some lifestyle adjustments may be enough to deal with the condition, while other cases require more specific interventions. “Most patients with this diagnosis will be able to control the disease with a balanced diet and physical activity. In which this control is not achieved with these measures, it will be necessary to use medications such as insulin, for example,” says Vera Cruz’s high-risk prenatal coordinator.

The professional also highlights the importance of constant accompaniment throughout pregnancy. “Therefore, the monitoring of blood glucose control, as well as a rigorous surveillance of the baby’s well-being, will be indispensable care throughout pregnancy.”

10. What is the importance of multidisciplinary work and what other experts should be involved?

An integrated approach between different health professionals can make all the difference in care offered during pregnancy. “Multidisciplinary work is crucial to ensure quality and safety of care, as well as promoting better maternal and neonatal outcomes. In this context, the performance of a team of professionals from various areas is fundamental for the holistic and integral health approach of pregnant women, aiming at prevention, early diagnosis and proper management of the conditions that may arise,” explains Elton Ferreira.

It also highlights the benefits of the diversity of knowledge in Monitoring of the pregnant woman. “In addition, it allows different perspectives to be considered, integrating knowledge and techniques from various areas of health, which results in more complete and personalized assistance. In addition to various medical specialties, other areas of health involved in this care include psychology, nutrition, physiotherapy and social assistance,” he concludes.

By Tiago Freitas