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High-risk pregnancy care
You may be referred to a perinatologist (a pregnancy doctor with training in caring for high-risk pregnancies) if you:
- are pregnant with more than one baby
- have had significant problems with previous pregnancies
- have a health problem or develop a health problem that may worsen during pregnancy (such as gestational diabetes)
- have a baby diagnosed with a medical condition that requires special care.
Minnesota Perinatal Physicians
Minnesota Perinatal Physicians has provided high-risk pregnancy care for women in the five-state region for more than 25 years. We have one of the largest perinatal practices in the nation with five locations in the Minneapolis / St. Paul area.
Gestational Diabetes: When You Have Diabetes during Pregnancy
Unlike other forms of diabetes, gestational diabetes lasts only as long as you are pregnant. This manual can help you understand what's happening to your body, how gestational diabetes is affecting you and your baby, and how it can be controlled.
Gestational diabetes class
Learn about the disease process and goals of treatment, risks to mother and infant, monitoring control, treatment plan including individualized meal plan and role of physical activity. Follow-up is available, as needed, with nurses and dietitian to maintain control throughout pregnancy and delivery.
Pregnancy and Diabetes Clinic
The Pregnancy and Diabetes Clinic at United Hospital in St. Paul provides treatment and evaluation for women who have diabetes during their pregnancy (gestational diabetes).
Pregnancy past 30
Record numbers of women are becoming pregnant later in life. Some will be first-time mothers, while others are having another child. Older mothers may be more financially stable or settled in their careers. They also may feel better able to care for a baby than a young mother would. But do older mothers and their babies face additional risks?
What to watch for
Research confirms that most women who become pregnant in their 30s and early 40s have safe, healthy pregnancies. But they do face a higher risk of some problems:
- Trouble conceiving: Starting in their early 30s, women become less fertile, and it may take them longer to get pregnant.
- Complications during pregnancy: Women older than age 30 have a higher risk for diabetes and high blood pressure during pregnancy.
- Greater risk of miscarriage: Women ages 35 to 45 have a 20 to 35 percent chance of miscarriage and women older than 45 have a 50 percent chance. For younger women, the rate is between 10 and 25 percent.
How does a mother’s age affect her baby? Researchers report that babies born to older mothers may have a higher risk for diabetes, prematurity and low birth weight.
Plan for good prenatal care
Keep in mind that most women older than age 30 have successful pregnancies and deliveries. Advances in medical care for both mother and baby can help prevent and treat many of the risks they face.
Early and regular prenatal care is key to having a healthy baby at any age. And it’s important to make sure you’re in good health before and during your pregnancy.
A nutritious diet can help promote the baby’s growth. And it’s best to avoid cigarettes and alcohol, which can harm the baby.
Discuss any pregnancy plans with your doctor, who can identify any special needs you may have and help make suggestions. Together, you and your doctor can help make pregnancy and motherhood wonderful experiences.
Pregnancy after 35
While getting pregnant and being pregnant after age 35 may be more difficult than it is for younger women, there's room for optimism. Those older than 35 typically are:
- better educated and better off financially
- more mature, helping them handle parenthood
- motivated to do what it takes to have a healthy pregnancy.
Women who become pregnant at 35 years or older have an increased risk of complications like these:
- diabetes or high blood pressure during pregnancy
- difficult, long labor
- the need to give birth by Cesarean section
- having a child with Down's syndrome.
Regular prenatal care can help catch complications early. Diabetes and high blood pressure need immediate medical attention.
Diabetes and pregnancy
Diabetes is more common the older we get. Untreated, uncontrolled diabetes increases the risk of miscarriage and problems at birth for the mother. For the developing baby, it may cause heart, digestive or urinary problems.
Pregnant women over 35 also run the risk of gestational diabetes. This type of diabetes clears up when the pregnancy is over.
Blood tests performed during pregnancy—the glucose screen and the glucose tolerance test—can help your doctor diagnose and treat gestational diabetes.
Doctors usually offer an amniocentesis to pregnant women over 35. The test usually takes place during the second trimester.
An amniocentesis, also called an amnio, examines the fluid that the fetus floats in. To get the fluid, a doctor inserts a thin needle into the uterus.
Amniocentesis can detect or rule out birth defects, such as Down syndrome or spina bifida.
Before having an amnio, you and your partner should discuss what you will do if you find out the fetus has problems. You might choose to end the pregnancy. Or you simply may want to know whatever you can so that you can prepare to care for a child with special needs.
Talk to your doctor about any concerns.
G. Curtis. Your Pregnancy: Every Woman's Guide. Fisher Books, Tucson, Arizona 85743-8416, 1999; Health Online, Inc.
; E. Lavin, S. Wood. The Essential Over 35 Pregnancy Guide. New York, New York, 10019, 1998. Reviewed by: Donald Wothe
, MD, medical director, Minnesota Perinatal PhysiciansFirst Published:
High blood pressure during pregnancy
An OB Homecare nurse checks a woman's blood pressure and answers questions about high blood pressure during pregnancy.
High blood pressure means the pressure of the blood inside your arteries is at a level higher than normal. This can create health risks at any time, and it is even more of a risk during pregnancy. If not treated, it can cause serious problems for you and your baby.
High blood pressure is also known as hypertension.
Your blood pressure has two numbers:
- The top number (systolic) shows the pressure in your arteries when your heart beats.
- The bottom number (diastolic) shows the pressure in your arteries when your heart rests.
During pregnancy, you have high blood pressure if your top number is more than 140 and the bottom number is more than 90.
Types of high blood pressure
There are two types of high blood pressure:
- chronic (long-lasting) hypertension . If you have chronic hypertension, you had it before your pregnancy. If you took medicine to control high blood pressure before you became pregnant you should be able to take it during pregnancy. Your doctor will monitor your medicine.
- gestational hypertension. Pregnancy can cause high blood pressure even if you've never had it before. It usually occurs after the 20th week and goes away soon after the baby is born.
With either type of high blood pressure, preeclampsia can occur. Preeclampsia means that, in addition to high blood pressure, there is protein in your urine. Your health care provider will monitor you closely.
Tell your health care provider if you have any of the following:
- a sudden weight gain of more than 1 pound a day
- swelling (edema) of your face and hands
- small amounts of dark urine
- severe or constant headache
- blurred vision or spots in front of your eyes
- pain in the upper right part of your abdomen, a dull achy indigestion feeling under your ribs or stomach area and/or flu-like symptoms
- a jittery feeling.
If not treated, preeclampsia can be life threatening to you or your baby. Call your health care provider if you have any of the above signs.
Risk factors for high blood pressure during pregnancy
The cause of high blood pressure during pregnancy is unknown. However, you are at a higher risk than other women if you:
- have a personal history of chronic hypertension (high blood pressure) or gestational hypertension
- have a family history of high blood pressure
- are pregnant for the first time
- are older than age 40
- are pregnant with more than one baby
- have certain medical conditions such as diabetes or kidney disease
- are African-American.
How you are tested for preeclampsia
To test for preeclampsia at each prenatal visit, the staff will check your weight and blood pressure, and test for protein in your urine. Your care provider is concerned about rapid weight gain, presence of protein in your urine, and increased blood pressure.
The test results help your health care provider know if you are developing preeclampsia. If you do develop preeclampsia, it can be treated.
How to treat preeclampsia
Treatment depends on if your symptoms are mild or severe.
- In general, for mild preeclampsia, you would have more clinic visits and more tests to check the health of your baby. These tests would include fetal movement counts and ultrasound. You may also be put on bedrest.
- In general, for severe preeclampsia, you may need to have home nursing services or stay in the hospital. The decision to deliver your baby will depend on the risks to you and the health of your baby. Labor may start on its own, be induced or your doctor may schedule a Cesarean. Your baby may need to stay in a special care nursery after delivery.
If you have any questions or concerns, please talk with your health care provider.
Preterm labor is labor that starts before 37 completed weeks of pregnancy. Your baby can have serious health problems if born too early.
Delivery can sometimes be prevented or delayed, giving your baby more time to grow. It can be difficult to tell the differences between true and preterm labor. Your health care provider can tell if you have preterm labor by giving you an exam and finding changes in your cervix.
Warning signs of preterm labor
Warning signs of preterm labor include:
- change or increase in vaginal discharge
- ruptured membranes (a slow leak, steady trickle, or sudden gush)
- six or more uterine contractions in one hour in a regular pattern
- menstrual-like cramps for more than one hour
dull backache below the waist for more than one hour
- increased pelvic pressure for more than one hour
- throbbing in the vagina, cramps in the thighs, or feeling your baby pushing down
- intestinal cramping with or without diarrhea or indigestion for more than one hour.
How contractions work and feel
Your uterus is shaped like a pear, sitting upside down in your pelvis. The "stem end" is called the cervix, which is the neck, or opening, at the bottom of your uterus.
The wall of your uterus is a muscle. When this muscle contracts, it becomes hard and tight just as any other muscle in your body would. When the contraction stops, your uterus becomes soft again.
Contractions can feel like a tightening sensation, like menstrual cramps, a dull backache or pain on the front of the thighs.
It is normal for your uterus to contract at times during your pregnancy. Your uterus is contracting too much if you feel six or more contractions an hour.
To check for contractions:
- Lie on your left side.
- Put your fingertips on your abdomen (just above your belly button).
- If you feel your abdomen tighten (become hard) and shorten (become soft), you are having contractions.
- Count the time between contractions from the start of one tightening to the start of another tightening. (Some contractions may be stronger than others.)
What to do if you think you're having contractions
If you think your water has broken, or if you are having heavy bleeding, call your health care provider or the hospital birth center at once.
If you are having cramps or pain:
- Drink two to three glasses of water or juice.
- Empty your bladder (urinate).
- Lie down on your left side and rest.
Recheck your symptoms. If you still have signs of labor, call your health care provider.
Tests for preterm labor
At the hospital, your health care provider may want to do some or all of the following tests:
- fetal monitor to check for contractions
- pelvic exam and cervix check
- lab tests for infection, to check the development of your baby's lungs, and/or tests to tell if you are at risk for delivering early.
Treatment for preterm labor
There are many ways to treat preterm labor. They include:
- fluids by mouth and/or intravenous (IV) line
- medicine to stop contractions
- medicine to treat infections
- bed rest. Lying down (instead of sitting or standing) can relieve pressure on your cervix. Avoid lying flat on your back. Lying on your side is better for blood flow to your baby.
Many times, preterm labor can be treated at home. Other times, a hospital stay is needed. Your health care provider will help determine which is right for you.
General instructions for preterm labor
- Empty your bladder often.
- Drink lots of fluids, especially water. Drink enough to keep your urine pale yellow in color.
- Eat foods high in fiber.
- Eat a well-balanced diet.
- Do not smoke, use alcohol or drugs.
- Avoid strenuous activities like jogging, aerobics or lots of stair climbing.
- Do not lift small children, heavy laundry, groceries, boxes, or objects at work.
- Avoid heavy cleaning such as scrubbing floors, moving furniture or vacuuming.
- Do not do yard work.
- Avoid car trips longer than 30 minutes, and do not fly.
- Avoid breast or nipple stimulation or sex.
Your health care provider will tell you if you have any activity restrictions.
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