Frequently Asked Questions
Why am I seeing a High Risk Doctor?
Your Obstetrician has referred you to our center to monitor your pregnancy for the chance of complications due to having a preexisting health condition or one you have developed during pregnancy. This does not mean in any way that you will not have a safe and healthy pregnancy.
Some of the pre-exisiting factors can include:
- Heart Disease
- Having fertility problems
- Low or High BMI
Health problems that can occur during pregnancy include:
- Preterm Labor
- Gestational diabetes
- Placenta previa
Why am I so tired? What’s the best sleep position?
It’s normal to feel more tired. You may also notice you need more sleep than usual. Try to get at least 8-10 hours per night. Listen to your body.
Try to sleep on your side to allow for maximum blood flow to baby. Lying on your back can cause your blood pressure to drop. You may also find it helpful to put a pillow behind your back and between your knees to improve comfort. As your pregnancy progresses, use more pillows and frequent position changes to stay comfortable.
Can I use a Jacuzzi?
Using a Jacuzzi or whirlpool bath is not recommended during the first trimester and should be limited to 15 minutes or less in the second and third trimester with the water temperature not exceeding 100 degrees.
Can I care for my pets?
If you have cats, please let us know. Avoid changing the litter box or use gloves to change it. Toxoplasmosis is a rare infection that you can get from cat feces.
What do I need to know about dental care?
Your teeth and gums may experience sensitivity throughout the pregnancy. Inform the dentist of your pregnancy and shield your abdomen if x-rays are necessary. Contact our office with any questions about dental care.
Can I have sex?
You can have sex unless you are having complications or sex becomes too uncomfortable. There are times when exercise and sex should be avoided. This includes vaginal bleeding, leaking amniotic fluid, preterm labor, chest pain, regular uterine contractions, decreased fetal movement, growth restricted baby, headache, dizziness or general weakness.
What is a high-risk pregnancy?
During pregnancy, about one quarter of women will have an identified “high risk” condition or sign. Identifying possible or actual “risk” is an important part of why your OB provider sees you so often during pregnancy. Most of conditions identified as “high risk” can be treated or monitored to allow you to safely deliver a healthy baby.
In mothers, these “high risk” conditions can be relatively minor and common. Being over the age of 35, or being overweight to more serious conditions, like having a defect in their heart or having a chronic disease before pregnancy such as diabetes, or lupus. For their babies, it can be growing larger or smaller than expected to more serious like have abnormality in development or virtually stop growing.
If during or before pregnancy you develop or have a “high risk” condition, it alerts your doctor to take special care of you and your baby by bringing in the High Risk team to help reduce and monitor any dangers to you and your baby. Working together with your doctor, we provide Integrated Obstetrics-High Risk Care for you throughout the remainder of your pregnancy.
What is Integrated Obstetrics/High Risk Care?
Our High Risk Team will first thoroughly evaluate your “high risk” condition, how it could affect either you or your baby. Together with you and your obstetrician, we will develop the best plan of treatment and monitoring for both you and your baby(ies) to have a healthy birth experience.
We work with Internal Medical Specialists, such as Cardiologists, and Endocrinologists when needed. Most importantly we work directly with your primary obstetric provider, coordinating your care, allowing you to continue your prenatal care in the convenience of your doctor’s office and through your delivery in the hospital.
What can I do to have a healthy pregnancy?
It is important to have a healthy lifestyle before, during and after pregnancy. This includes eating healthy gaining the correct target weight based on your BMI (Body Mass Index) following any special medical nutritional recommendations, and exercising daily.
Equally important is to diligently follow the direction of your provider, and to continue prenatal appointments as a part of your care plan.
Can a high-risk pregnancy be prevented?
Your risks may be reduced or controlled by taking part in a Pre-Conception Counseling session before you become pregnant. You can start a preventive care plan.
In general these important steps can help a woman who is looking to conceive or has already conceived.
- Stop smoking cigarettes (or illegal substances such as marijuana)
- Stop drinking alcohol
- Don’t use any illicit drugs
- Exercising at least 30 minutes a day and achieving a healthy weight before pregnancy
However, despite following a “right” path, problems can still occur.
For women with a prior complicated pregnancy, such as recurrent pregnancy loss, stillbirth or preterm labor, we will review prior medical records and investigate possible treatable causes, such as uterine anomalies, inherited disorders, incompetent cervix and develop a strategy to reduce their recurrence.
What is preconception counseling?
If you feel that you may be at risk to be considered a high-risk pregnancy, preconception counseling may be the right avenue for you.
During preconception counseling our team discusses disease such as diabetes, hypertension, thyroid disease, cardiac disease, lupus and autoimmune disorders, HIV and infectious diseases.
When women have medical conditions, the most important steps often need to occur before pregnancy, to optimize her health. Planning a pregnancy when you have a serious medical condition with your doctor and the specialist is one of the most important steps you can take to have a healthy pregnancy. Reviewing any and all medicines that you take is important. Sometimes different medicines are substituted because they are known to be safer during pregnancy.
It is important for a women not stop any medications unless specifically told to do so.
Have more questions or need more information?
Give us a call and we’ll be happy to answer any questions you might have (702) 255-3547. Or schedule an appointment if you would like to come in and talk to someone in person. Or you can send us a message and we will contact you.
Glossary for Common Conditions
- Gestational Diabetes Mellitus is a pregnancy-induced condition in which a non-diabetic woman develops diabetes during her pregnancy. Gestational diabetes is routinely screened between 24-28 weeks gestation.
- Preeclampsia is a syndrome that includes elevated blood pressure, increased urinary protein and changes in liver enzymes in a pregnant woman. Left untreated, the condition can cause long-term health problems including fatality for the mother and/or baby.
- Eclampsia is more severe than preeclampsia and may induce seizures and a coma.
- Multiple Gestations – Twin, triplet and quadruplet pregnancies are considered to be high-risk pregnancies, as they often experience complications, such as preterm labor, preeclampsia, gestational diabetes, twin-to-twin transfusion syndrome, and tangled umbilical cords.
- Placenta Previa occurs when the placenta attaches to the uterine wall so close to the cervix that it partially or completely covers the cervix. This can result in additional bleeding during pregnancy, hemorrhage during labor, and/or complications for the baby if the placenta detaches from the uterus prior to birth.
- Cervical Incompetence – premature shortening and dilation of the cervix that is not caused by labor but by structural weakness in the cervix itself. This can be caused by previous cervical injury, surgery, DES (Diethylstilbestrol, or synthetic estrogen) exposure or inherited physical conditions.
- Repeated Pregnancy Losses– 10-15% of all known pregnancies end in miscarriage (pregnancy loss before twenty weeks). When pregnancy loss occurs two or more times in a row, it is called Repeated Miscarriage. There are many causes for miscarriage; most have no known cause, but sometimes there are causes that may be treated.
- Antiphospholipid Antibody Syndrome (APS) is an autoimmune blood clotting disorder that may cause problems such as recurrent miscarriage, preeclampsia, poor placental function, embolism or stillbirth.
Infections That Can Cause High-Risk Pregnancy
- HIV/AIDS– HIV positive women run the risk of passing the HIV virus to their unborn baby during pregnancy, birth or while breastfeeding. There are, however, effective ways to prevent the transmission of HIV/AIDS to from mother to infant.
- CMV (Cytomegalovirus) is the most common type of congenital viral infection and occurs when a mother passes CMV to her unborn baby.
- Rubella – unborn babies exposed to rubella through their mother’s bloodstream are at risk for congenital rubella syndrome.
- Chicken Pox – a fetus of a woman previously unexposed to chicken pox is at risk for birth defects and the mother is at greater risk for developing complications.
- Congenital Conditions That May Cause a High Risk Pregnancy:
- Congenital Defects are defined as abnormalities of structure, function or body mechanism that are present at birth. These deformities lead to mental or physical disabilities and may be fatal. There are over four thousand different birth defects.
- Congenital Heart Defects can be identified via echocardiography and help prepare doctors for any issues at birth.
- Neural Tube Defects – any problem in which the fetal neural tube was malformed and failed to close properly. NTDs can occur up and down the spine, from the forehead to the tail of the spine. A neural tube defect involving the skull is called an encephalocele. A NTD along the spinal column spine is called spina bifida. If the neural tube defect occurred while the brain was forming, failing to properly form a skull, it is called anencephaly.
Genetic Disorders That Cause A High-Risk Pregnancy
- Genetic Disorders such as extra or missing chromosomes (or chromosomal fragments) can be detected via karyotyping – a process in which the 46 chromosomes of the fetus (23 from Mom, 23 from Dad) are analyzed. Genetic problems can happen for a number of reasons.
- Gene Deletions, Translocations, and Inversions: a mutation in which part of a chromosome or DNA sequence is missing or abnormally shaped. Any amount of material can be deleted, from a single base pair to an entire piece of chromosome.
- Translocation – a chromosomal abnormality caused by the rearrangement of parts between two nonhomologous chromosomes. Translocation may be inherited from a parent or arise spontaneously and may not cause any developmental problems in children who have them. As adults, those with chromosomal translocations may be at higher risk for infertility and miscarriage.
- Chromosomal Inversions – a chromosomal rearrangement in which a segment of chromosome breaks and rearranges within itself, reversed, end to end.
- Trisomy Disorders – three copies of a particular chromosome exist rather than the normal two. Down Syndrome (Trisomy 21), Trisomy 13, and Edward Syndrome (Trisomy 18) are examples of trisomy disorders.
- Monosomy Disorders – another form of chromosomal error in which one member of a pair of chromosomes are missing. There are too few chromosomes rather than too many. The only non-fatal monosomy is Turner Syndrome. The rest are incompatible with life.
- Microdeletion – the missing part of a chromosome is so small that it affects a single gene or only a few genes.
- Partial Monosomy exists when a portion of the chromosome is deleted, but the rest has two copies.
- Turner Syndrome – women missing all or part of an X chromosome. It is the only non-fatal full monosomy.
- Cri du Chat syndrome partial deletion on the arm of Chromosome 5, named for the cat-like cry of newborns with this condition.
- 1p36 Deletion Syndrome – partial monosomy caused by the deletion at the end of the short p arm chromosome.
- Wolf-Hirschhorn Syndrome (also known as chromosome deletion 4p syndrome due to the partial deletion on the short arm of chromosome 4).
- Disorders of the Sex Chromosomes – Certain disorders are caused by genetic abnormalities of the sex chromosomes. For a child to be biologically male, he must have XY chromosomes. For a child to be genetically female, she must have two XX chromosomes.
- Turner Syndrome occurs when a woman inherits only one X chromosome.
- Kleinfelter Syndrome occurs when boys are born with XXY or XXXY sex chromosomes.
Some genetic problems are X-Linked, meaning they are carried by the X Chromosome. Females may be carriers these diseases, but because they have another X chromosome, the abnormal X chromosome may be canceled out. Males only have one X chromosomes and are generally the ones afflicted with the disease.
- Fragile X causes mental handicaps in boys.
- Hemophilia A is another X-Linked Recessive disorder which impairs the body’s ability to properly control blood clotting or coagulation.
- Duchenne Muscular Dystrophyis an X-Linked Recessive disorder that gradually weakens the body’s muscles.
- Lesch-Nyhan Syndrome– X-Linked Recessive Disorder that causes uric acid buildup in all bodily fluids as well as moderate mental handicaps and poor muscle control.
- Gene Mutations – some genetic problems are caused by a single gene that’s present but altered in some way, but often all chromosomes are present. DNA screening techniques are use to detect specific gene abnormalities.
- Cystic Fibrosis (CF)is a progressive genetic disorder that affects the entire body, but especially the lungs and digestive system.
- Tay-Sachs Disease is an autosomal recessive genetic disorder. It’s most common variant is infantile Tay-Sachs disease which causes a relentless deterioration of mental and physical abilities beginning at age six months. Death by age four is standard.
- Sickle Cell Anemia is an autosomal recessive genetic blood disorder caused by a mutation in the hemoglobin gene. Sickle cell anemia is characterized by blood cells that assume an abnormal, rigid sickle shape.
- Achondroplasia Dwarfism is a bone growth disorder in which the bones are severely shortened. It is the most common type of dwarfism.