High-Risk Pregnancy: Understanding the Risks and How We Manage Them
Not every pregnancy is straightforward. Understanding what makes a pregnancy high-risk — and how specialist care can make a difference — is essential for every expectant mother.
By Dr. Amrendra Prasad Kushwaha
A high-risk pregnancy is one in which the mother, the baby, or both face an elevated chance of health complications before, during, or after delivery. Being classified as high-risk does not mean something will go wrong — it means you and your baby need closer monitoring and specialist care.
What Makes a Pregnancy High-Risk?
Maternal Factors
- Age: Under 17 or over 35 years
- Pre-existing conditions: Diabetes, hypertension, thyroid disorders, heart disease, kidney disease, epilepsy
- Obesity: BMI over 30
- Multiple pregnancy: Twins, triplets, or more
- Previous pregnancy complications: Pre-eclampsia, preterm birth, stillbirth, caesarean section
- Infections: HIV, hepatitis B, rubella, cytomegalovirus
Pregnancy-Related Factors
- Gestational diabetes mellitus (GDM)
- Pre-eclampsia and eclampsia
- Placenta praevia or placental abruption
- Intrauterine growth restriction (IUGR)
- Polyhydramnios or oligohydramnios (too much or too little amniotic fluid)
- Preterm labour (before 37 weeks)
- Rhesus incompatibility
Signs You Should See a Specialist
Seek urgent medical attention if you experience:
- Severe headaches or visual disturbances
- Sudden swelling of face, hands, or feet
- Decreased fetal movements
- Vaginal bleeding
- Persistent abdominal pain
- Difficulty breathing
How High-Risk Pregnancies Are Managed
Increased Monitoring
Women with high-risk pregnancies are seen more frequently — sometimes every 1–2 weeks rather than monthly. Each visit includes:
- Blood pressure measurement
- Urine dipstick (for protein)
- Fetal heart rate assessment
- Growth monitoring
Specialist Ultrasounds
- Anomaly scan at 18–20 weeks
- Growth and Doppler scans from 28 weeks onwards
- Biophysical profile to assess fetal wellbeing
Medications and Interventions
Depending on the condition:
- Low-dose aspirin (for pre-eclampsia prevention)
- Insulin or oral hypoglycaemics (for GDM)
- Antihypertensives
- Progesterone supplements (for threatened preterm labour)
- Corticosteroids (to mature baby's lungs before preterm delivery)
Planning the Birth
For many high-risk pregnancies, the timing and mode of delivery must be carefully planned. Some women will benefit from an elective caesarean section or induction of labour before their due date.
The Role of Specialist Care
As a specialist in high-risk obstetrics and maternal-fetal medicine, my role is to:
- Identify risk factors early in pregnancy
- Formulate an individualised care plan
- Monitor both mother and baby throughout pregnancy
- Manage complications promptly if they arise
- Guide you through delivery with safety as the priority
Your Role in a High-Risk Pregnancy
You are not a passive participant. Here is how you can support a healthy outcome:
- Attend all scheduled appointments
- Take prescribed medications consistently
- Follow dietary guidance (especially for GDM)
- Monitor fetal movements from 28 weeks
- Avoid smoking, alcohol, and recreational drugs
- Report any new or worrying symptoms promptly
A high-risk diagnosis can feel daunting, but with the right care and support, most women go on to have healthy babies. If you have concerns about your pregnancy or have been told you are high-risk, please reach out for a consultation.
Contact: 984-3504431 | Hope Hospital, Kathmandu