We offer prenatal monitoring and consultation for expectant mothers with complicated pregnancies who may be at risk due to multiple births, age considerations or chronic health conditions. Our high-risk team consists of dedicated physicians, nurses, nutritionists and social workers who provide individualized care in convenient settings.
Wherever possible, women are co-managed with their obstetrical care providers so that travel is minimized and care is optimized.
While our tiniest patients are supported by the finest high-risk obstetric service and a dedicated obstetric anesthesiology group, our goal is that they spend as many weeks as possible in the best incubator in the world: their mother's womb. We strive to have family and baby meet in the most normal, healthy way possible. However, we understand complications can occur.
High-risk pregnancies include but are not limited to
Autoimmune responses in the mother may target the fetus when auto antibodies cross the placenta, making it very important for pregnant women with autoimmune disorders to be followed closely in pregnancy. Diseases under this title include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (scleroderma) and autoimmune thyroid disease, such as hypothyroidism (Hashimoto’s thyroiditis) and hyperthyroidism (Graves’ disease). The unique characteristics of each autoimmune disease are key to understanding the effect of pregnancy upon the mother’s disease course and her fetus.
Chronic hypertension is defined by a blood pressure of 140/90 mm Hg and/or greater. It is diagnosed preconception or in the first half of pregnancy with no outward underlying cause. It may also be diagnosed in women during pregnancy who are on antihypertensive medications with no other apparent causes. Chronic hypertension can put pregnant women at increased risk for preeclampsia.
Congenital heart disease
Risks associated with pregnancy in women with congenital heart disease affects mother and her growing fetus. The risks of pregnancy to mother and fetus are directly related to the severity of the patient’s heart disease. It is very important to have a management plan discussed with a perinatologist and cardiologist for the welfare of both patients. This management plan will include pregnancy, labor and the postpartum period.
Connective tissue disease
There are 5 major diffuse connective tissue diseases that exist, according to classification schema: rheumatoid arthritis (RA), scleroderma, systemic lupus erythematosus (SLE), polymyositis and dermatomyositis. Another disorder, Sjogren’s syndrome, is commonly associated with each of these diseases but is called primary Sjogren’s syndrome when it occurs alone. Definitive diagnosis of each of these disorders is based upon criteria derived from expert opinion and updated diagnostic criteria.
Deep vein thrombosis and/or pulmonary embolism
Deep venous thrombosis, or DVT, is the development of a blood clot in a deep vein. Clots that break free and travel through the circulatory system to the lungs can cause a pulmonary embolism. Finding and treating DVT is the only way to prevent pulmonary embolism. Close monitoring and possible treatment for a current thrombosis or a history of a thrombosis or embolism is important in the care of a pregnant woman and her fetus.
Diabetes mellitus (DM)
Preexisting diabetes comprises cases of type 1 (insulin-dependent) and type 2 (non-insulin-dependent diabetes). Most complications seen in pregnancy and fetal development can be associated with maternal blood glucose levels that are elevated; therefore optimal glycemic control in all stages of pregnancy is critical.
Gestational diabetes mellitus (GDM)
In pregnancy, the placenta makes a hormone that does not allow insulin to work as effectively. This is called insulin resistance. As pregnancy progresses, placental hormones can cause this resistance to increase which, in turn, can cause blood glucose levels to rise. Women who have diabetes only in pregnancy are diagnosed with GDM. Controlling high blood sugars in pregnancy will help promote a healthy mother and baby.
Cervical insufficiency is the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, labor or both in the second trimester.
Liver failure / disease
Liver disease can include viral hepatitis, gallstones, cirrhosis and underlying chronic liver disease, as well as liver dysfunction, that can potentially occur directly related to pregnancy. Other disease of the liver can include hyperemesis gravidarum, intrahepatic cholestasis, preeclampsia and associated liver diseases, such as HELLP syndrome (hemolysis (H), elevated liver tests (EL), and low platelet count (LP)) and acute fatty liver. Early detection, diagnosis and treatment are essential for maternal and fetal survival in some of these conditions.
Recurrent preterm birth
Recurrent preterm birth is mostly defined as 2 or more deliveries before 37 completed weeks of gestation. Patients with a history of a preterm delivery are at risk for subsequent preterm birth. Preterm birth is considered a leading cause of perinatal morbidity and mortality worldwide, and early prenatal surveillance is suggested for optimal maternal and fetal outcome.
Renal failure is a challenging clinical problem when associated with pregnancy. It is important to have an understanding of the normal functioning of the kidney in pregnancy and the underlying renal disease so that differentiation can be made between worsening symptoms related to the underlying disease and symptoms that could be a result of problems in the pregnancy. This differentiation allows appropriate therapeutic decisions to be made to preserve both maternal and fetal well-being.
- Gallbladder disease
- Benign tumors
- Maternal trauma, such as automobile accidents
Thrombophilia or bleeding disorders
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