Some
pregnant women are considered to be at " higher
risk" than the most others. They include women who have diabetes,
heart disease, or high blood pressure, or who develop
these conditions during pregnancy or labor. They also include
women who are carrying their fifth or later child ; who are
carrying more than one baby; who are under 17 or over 35; who are
over 30 and carrying their first child; or who develop signs or preterm
labor. the degree or risk varies with each or these conditions and
should be thoroughly explained to you by your doctor.
If
you are in a higher-risk category, the management of your
pregnancy and labor may need to be varied from that of a low-risk
women. Consequently, not all or the options discussed in this
book may be available to you.
Some
of the more common conditions that place women in
the higher-risk category are discussed below.
Gestational
Diabetes
Diabetes
is a condition characterized by a high level of sugar, or
glucose, in the blood. Diabetes that occurs only in pregnancy
is known as gestational diabetes. During pregnancy, hormones cause
the women's insulin to be less effective at
metabolizing glucose. The resulting high blood sugar can
lead to complications in both the woman and baby, although a third
of afflicted women become gestational diabetics with
subsequent pregnancies. In later life, they are also more
like to develop non-insulin-dependent diabetes. Most
women who are well controlled during pregnancy have good
pregnancies and healthy babies.
The
risk factors for developing gestational diabetes are family
history, previous large babies , or previous gestational debates.
The condition is more common in women who are
obese or over the age of 25. Most practices screen all women at 28
weeks for the condition with the glucose tolerance
test . Once a positive diagnosis in confirmed, the pregnant woman
is placed on a diabetic diet. Home monitoring of blood
sugar is performed several times a day . If diet alone
does not control the blood sugar, insulin may have to be
given.
The
babies of untreated diabetic women may be very large, making
delivery more difficult. Other complications include
respiratory difficulties, jaundice, a low level of
calcium in the blood, and stillbirth. If the diabetes in not
controlled, hypoglycemia (low blood sugar) may occur after birth.
The woman's high level of insulin may cause his
own blood sugar level to drop very low. Nursing soon after birth helps
to prevent hypoglycemia.
Women
who have diabetes are more likely to develop pregnancy -induced
hypertension. To prevent stillbirths, their doctors may induce
labor before or on the due date. If the induction is
not successful, a cesarean section is performed. Infection
and postpartum hemorrhage are also more common in diabetic
women.
Pregnancy
-Induced Hypertension
Hypertension
(high blood pressure ) that occurs during pregnancy is called
pregnancy -induced hypertension(PIH). Most women who develop PIH
did not have hypertension before pregnancy and will not have it
after. PIH was formerly known as toxemia. While the cause of PIH
is unknown, some studies suggest that the blame lies
with an imbalance of the substances that regulate the
constriction and dilation of the blood vessels. The risk factors
include heredity, a diet low in protein or calcium, a history of
preeclampsia prior to 32 weeks gestatio , chronic high boood
pressure, kidney disease, lupus, diabetes, multiple pregnancy, age
( under 20 or over 35), and being overweight. A new theory
states that PIH may be an immune response to a new sex partner,
since 85 percent of cases occur in first -time pregnancies.
Several studies have sh0wn that a good diet can reduce the
risk of developing PIH . A diet containing 75 to 100 grams of
protein and 1,500 to 2,000 milligrams of calcium is
recommended.
PIH
affects both the woman and the fetus. High blood pressure
constricts the blood flow to the uterus. This can
result in the baby receiving less oxygen and nutrients,
which will affect his growth . In addition, the placenta may
separate from the wall of the uterus before delivery
and result in bleeding and shock. If untreated, PIH can become
preeclampsia, which is characterized by the face and hands. It may
be necessary to induce labor if the blood pressure is not
controlled. This may lead to a premature infant. Rarely,
preeclampsia death of the woman or baby.
Treatment
of PIH consists of bed rest for mild conditions . Occasionally, a
woman must be hospitalized. If the blood pressure is
not controlled, delivery by induction of labor of cesarean
section may be necessary to save the lives of the woman and
baby. The medication magnesium sulfate is administered
intravenously to prevent convulsions. The risk of seizure
diminishes 48 hours after delivery of the baby.
Multiple
Pregnancy
If
you are pregnant with more than one baby - with twins,
triplets, or more your pregnancy is called a multiple pregnancy.
Fraternal twins are more common than identical twins and are the
result of two sperm fertilizing two eggs .
Fraternal twins may or may not be the same sex and are
on m0re alike appearance than any other siblings. Identical twins
occur less frequently and are the result of one sperm
fertilizing one egg, which them separates. Since identical
twins carry the same genetic material , they are
always the same sex always look alike . and always
have the same blood type . They may be mirror images of each
other.
During
pregnancy, an increased demand is placed on the body of a
woman carrying more than one baby as well as additional
placentas or one larger placenta . The discomforts of pregnancy
are accentuated, since there is an increased
demand on the circulator7 system and the uterus is larger in
size . The chances of PIH and preterm labor are greater. For
these reasons , many physicians place these women on
bed rest at around 28 weeks gestation.
Women
experiencing a multiple pregnancy have higher protein and caloric
requ9rements. Additional protein is necessary to
provide for adequate growth of the babies and ensure good
muscle tone of the over distended uterus. Women who eat well
during pregnancy decrease their chances for
complications and increase their chances
for delivering at term.
Preterm
Labor
If
a baby is born before the thirty seventh week of pregnancy -
more than 3 weeks early-the birth is called
oreterm and the baby premature. Preterm birth represents the
greatest health risk to newborns. Preterm babies have an
increased risk of neonatal problems. Premature babies often have
difficulty in maintaining their body temperature. In
addition, their sucking may be weak, and they are
more susceptible to infection.
Women
who are more likely to go into preterm labor
include those who had a previous miscarriage or preterm
birth; who have an over-distended uterus from a
multiple pregnancy or from an excess of amniotic fluid; who smoke
, take drugs, or are malnourished ; who are
under the age of 18 or over 35 ; who are experiencing
a high degree or enduring other stressful working
conditions ; and who have a vaginal or urinary
tract infection or an infection of the membranes of the
amniotic sac.
Preterm
labor can often be stopped if it is caught in time . The
treatment for preterm labor includes bed rest. antibiotics, if
indicated, for infection; and possibly medications to relax
the uterus and stop the contractions. While some
studies question the efficacy of bed rest., it is the current
treatment of choice.
The
US Food and Drug Administration (FDA) recently approved a test
that can predict whether a pregnant woman is about to experience a
preterm birth. The test detects a substance called fetal
fibronectin in the cervical/vaginal secretions. Fetal
fibronectin is an adhesive protein that serves as a "natural
glue " on the placenta. The substance changes into a
lubricant just before labor begins. It
should not be present in the cervical/ vaginal
secretions after the twenty-second week of pregnancy
unless there is a problem , such as preterm labor of an infection.
Its presence indicates a high risk if delivering within the
next 2 weeks.
In
cases of impending preterm birth between 24 and 34 weeks gestation
, a treatment is available that accelerates fetal lung
maturity. Synthetic steroids have been shown to reduce the
incidence of respiratory distress syndrome and brain hemorrhage in
newborns by 50 percent and to reduce death rates by 40 percent.
According to a recommendation of the National
Institutes of Health (NIH), this medication should be used when
delivery prior to 34 weeks gestation is likely, unless the
medication will have an adverse effect on the woman or
delivery is imminent.
If
you experience any signs of labor more than 3 weeks before your
due date, contact your caregiver right away.
New
PIH findings
Researchers
have new findings indicating that pregnancy induced
hypertension results from a cellular defect that occurs
early in gestation and affects the implantation of
the placenta. They are hopeful that this
information will lead to the development of a test for
the condition.
Signs
of preterm labor
The
following symptoms may be indications of preterm labor:
-
More
than for uterine contractions in 1 hour.
-
Menstrual
-like cramps, constant or intermittent.
-
Abdominal
cramps , with or without diarrhea.
-
Backache,
constant or intermittent.
-
Pelvic
pressure or the feeling that the baby is pushing
down .
-
Sudden
increase in vaginal discharge.
-
If
you note any of the above symptoms, contact your
caregiver immediately.
