A SMOOTH pregnancy and successful delivery is what every woman anticipates when she conceives.
Pregnancy is a period of great joy, but also one marked by anxiety if it's a high-risk experience.
One in 10 pregnancies is high risk and these cases have to be properly monitored and managed.
Pantai Hospital Kuala Lumpur obstetrician and gynaecologist and maternal foetal medicine specialist Dr Muniswaran Ganeshan says it's not a single factor, but a combination that results in high-risk pregnancies.
These include pregnant women with diseases such as cancer, diabetes, epilepsy, and psychiatric disorders such as depression, as well as those who have undergone organ transplants.
In the past, such women would be advised to avoid getting pregnant, but these days, their pregnancies can be successful if properly managed from the beginning.
Obesity in expectant mums is another factor that pushes a pregnancy into the high risk category.
Dr Muniswaran says obese women are more likely to have diabetes or develop gestational diabetes during pregnancy.
They may also develop sleep disorders and breathing difficulties in the second half of the pregnancy and have a higher tendency to develop clots, known as DVT
"Her chances of experiencing birth trauma, caesarian births and bleeding after delivery is also higher," says Dr Muniswaran.
The baby is more likely to be born big given the mother's weight and the baby's risk for diabetes is also higher.
"How healthy the mum is during pregnancy, programmes her baby's health well into adulthood."
START EARLY
With high risk pregnancies, the approach is to intervene early, before a complication happens and take steps to modify certain risk factors in the mother so the pregnancy is safer, with a better outcome.
The mother would also need advice and strategies on meeting the needs of both her health condition and her pregnancy at the same time.
Dr Muniswaran says patients who are already on certain medications due to their health condition should not abruptly stop taking them once they are pregnant or planning to get pregnant.
"There are medications that are safe during pregnancy and medications which can be adjusted to ensure safety or safer alternatives provided so seek expert advice. For example, in the case of women with epilepsy, not all epilepsy medications are unsafe during pregnancy."
If a woman has had a previous stillbirth, it's also important to look into the possible causes as this helps prevent it from happening in subsequent pregnancies.
In women with cancer, the cancer has to be managed while supporting the pregnancy but this is not impossible either, explains Dr Muniswaran.
"Most complications are not recurrent and we can actually modify the risk factors in some cases, especially for incidents like stillbirths and preterm deliveries."
Even with preeclampsia, a dangerous condition that in the past used to result in the death of mothers and babies, early detection and intervention now helps save lives.
The challenge lies in the fact that many women with high risk pregnancies don't seek expert care as early as possible.
They tend to come in after complications have set in, usually mid way through the pregnancy.
Many don't realise that the health of the husband matters too, including his age, weight, lifestyle and the medications he's taking.
Dr Muniswaran says an early start, even at the preconception period, makes a huge difference in handling a high-risk pregnancy as the mother can be medically assisted and advised to manage her health condition. And certain risk factors may also be brought under control so her pregnancy is smoother and safer.
RISKY PREGNANCIES
High-risk pregnancies affect:
1. Women who have medical, surgical or genetic problems and are planning to get pregnant
These women may have conditions such as diabetes, kidney problems, heart disease or cancer.
2.Women with no medical problems but develop pregnancy complications
These include preeclampsia and gestational diabetes.
3.Women with a previous adverse pregnancy outcome
This includes a stillbirth, preterm delivery or recurrent miscarriages.
PREGNANCY TIPS
• Zero alcohol
• Avoid smoking and exposure to second-hand smoke
• Control caffeine intake — one mug of coffee a day is considered safe
• Don't ignore/normalise symptoms like severe vomiting, pain, feeling breathless or headache
• Vaccinations are generally safe during pregnancy
• Exercise for 20 minutes a day but avoid weight bearing exercises
• Avoid raw food, unpasteurised fresh milk and unhygienic ways of food preparation
• See a doctor preconception
POST PARTUM
THE fourth trimester of pregnancy is traditionally known as the confinement period.
Pantai Hospital Kuala Lumpur obstetrician and gynaecologist and maternal foetal medicine specialist Dr Muniswaran Ganeshan says this is also a high-risk period for mums because the chances of a woman dying is highest in the first three months after childbirth.
"There's a higher risk of depression, heart problems, infections and clots and in Malaysia, 59 per cent of deaths among pregnant women occur after birth."
He adds that during pregnancy, medical care is routinely provided but upon delivery, these women switch from medical management to traditional midwives or confinement taboos, which may be subjected to many practices that are not always healthy or wise.
"What happens during pregnancy doesn't necessarily end after pregnancy so care and caution should continue during the post delivery period."
For example, if a woman developed gestational diabetes during childbirth, she can have diabetes after pregnancy too and if she experienced preeclampsia, she has a higher risk of heart failure and stroke later on.
It is for these reasons that the health of the mother must be monitored and managed throughout pregnancy and even after.
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