High-Risk Pregnancy
A high-risk pregnancy does not mean an inevitable complication — it means that closer, specialized monitoring is needed to ensure the health of mother and baby.
Symptoms and warning signs in pregnancy
Certain symptoms during pregnancy require immediate contact with the obstetrician — without waiting for the next scheduled visit.
- Severe or persistent headache, visual disturbances or flashing lights — possible signs of preeclampsia.
- Sudden, significant swelling in the hands, face or feet.
- Vaginal bleeding of any amount after the 20th week.
- Loss of amniotic fluid or sensation of continuous leakage.
- Painful or regular contractions before the 37th week.
- Noticeable decrease in fetal movements compared to usual.
- Sudden shortness of breath, rapid heartbeat or chest heaviness.
- High fever, painful urination or signs of urinary tract infection.
Risk factors — which pregnancies are classified as high-risk
Classification as a high-risk pregnancy is made by the obstetrician and can arise from pre-existing factors or develop during the course of the pregnancy.
- Chronic hypertension or pregnancy-induced hypertension / preeclampsia in a previous pregnancy.
- Diabetes mellitus (type 1, type 2 or poorly controlled gestational diabetes).
- Autoimmune diseases: Lupus (SLE), antiphospholipid syndrome, thrombophilia.
- Maternal cardiac disease: Congenital heart defects, arrhythmias, valvular disease.
- Multiple pregnancy: Twins, triplets — increased risk of preterm birth and perinatal complications.
- Previous preterm birth (<37 weeks).
- Fetal anatomical abnormalities or chromosomal disorders.
- Intrauterine growth restriction (IUGR) or abnormal Doppler findings.
- Maternal age under 18 or over 40.
- Obesity (BMI >35) or severe malnutrition.
How risk assessment is performed in pregnancy
Risk assessment begins at the first visit and is re-evaluated throughout the pregnancy.
- Detailed obstetric history: Previous pregnancies, complications, chronic diseases, medication.
- Blood pressure and body weight: Monitoring at every visit.
- First trimester laboratory tests: Complete blood count, glucose, renal and hepatic function, thyroid, thrombophilia screening when indicated.
- First trimester ultrasound with uterine artery Doppler: Early prediction of preeclampsia risk.
- Oral glucose tolerance test (OGTT): At 24–28 weeks for gestational diabetes.
Specialized monitoring of mother and fetus
The monitoring schedule is tailored to the cause and degree of risk — more frequent visits, specialized ultrasounds and close collaboration with other specialties.
- Fetal growth ultrasounds: Every 2–4 weeks for assessment of growth, amniotic fluid and position.
- Arterial Doppler: Assessment of blood flow in the umbilical cord and fetal middle cerebral artery — an index of fetal wellbeing.
- Cardiotocography (CTG/NST): Recording of fetal heart rate in relation to movements — scheduled or as needed.
- Cervical length measurement: Assessment of preterm birth risk.
- Collaboration with internist/cardiologist/nephrologist: When maternal disease requires parallel specialist management.
Birth planning and postpartum care
The timing and mode of delivery are determined by the condition of mother and baby — there is no automatic indication for caesarean section in every high-risk pregnancy.
- Delivery planned from 34–37 weeks depending on the pathology.
- Choice of delivery in a centre with a NICU (Neonatal Intensive Care Unit) if prematurity is expected.
- Detailed briefing of the obstetric team about the pathology and management plan.
- Postpartum monitoring: Increased risk of complications after birth (thrombosis, hypertension, depression).
Treatment and management of pregnancy complications
Treatment aims to prolong the pregnancy as much as possible while ensuring safety for both mother and baby. Every decision is individualized.
- Low-dose aspirin: Given from the first trimester for preeclampsia prevention in high-risk pregnancies.
- Antihypertensives safe in pregnancy: Nifedipine, labetalol, methyldopa — for blood pressure control.
- Insulin or metformin: For glycemic control in gestational diabetes not managed by diet.
- Progesterone (vaginal): For preterm birth prevention in short cervix.
- Corticosteroids (betamethasone): For fetal lung maturation when preterm birth is imminent.
- Hospitalisation and monitoring: For severe complications (severe preeclampsia, HELLP syndrome) hospitalisation is necessary.
Symptoms
Certain symptoms during pregnancy require immediate contact with the obstetrician — without waiting for the next scheduled visit.
- Severe or persistent headache, visual disturbances or flashing lights — possible signs of preeclampsia.
- Sudden, significant swelling in the hands, face or feet.
- Vaginal bleeding of any amount after the 20th week.
- Loss of amniotic fluid or sensation of continuous leakage.
- Painful or regular contractions before the 37th week.
- Noticeable decrease in fetal movements compared to usual.
- Sudden shortness of breath, rapid heartbeat or chest heaviness.
- High fever, painful urination or signs of urinary tract infection.
Classification as a high-risk pregnancy is made by the obstetrician and can arise from pre-existing factors or develop during the course of the pregnancy.
- Chronic hypertension or pregnancy-induced hypertension / preeclampsia in a previous pregnancy.
- Diabetes mellitus (type 1, type 2 or poorly controlled gestational diabetes).
- Autoimmune diseases: Lupus (SLE), antiphospholipid syndrome, thrombophilia.
- Maternal cardiac disease: Congenital heart defects, arrhythmias, valvular disease.
- Multiple pregnancy: Twins, triplets — increased risk of preterm birth and perinatal complications.
- Previous preterm birth (<37 weeks).
- Fetal anatomical abnormalities or chromosomal disorders.
- Intrauterine growth restriction (IUGR) or abnormal Doppler findings.
- Maternal age under 18 or over 40.
- Obesity (BMI >35) or severe malnutrition.
Risk assessment begins at the first visit and is re-evaluated throughout the pregnancy.
- Detailed obstetric history: Previous pregnancies, complications, chronic diseases, medication.
- Blood pressure and body weight: Monitoring at every visit.
- First trimester laboratory tests: Complete blood count, glucose, renal and hepatic function, thyroid, thrombophilia screening when indicated.
- First trimester ultrasound with uterine artery Doppler: Early prediction of preeclampsia risk.
- Oral glucose tolerance test (OGTT): At 24–28 weeks for gestational diabetes.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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