High-risk pregnancy | Dr Anu Mahadik Sydney Obstetrician

High-risk `
pregnancy

High-risk pregnancy | Dr Anu Mahadik | Obstetrician Sydney

What is a high risk pregnancy?

A pregnancy is considered high risk if you, or your baby, are at an increased risk of health problems before, during or after delivery. If your pregnancy is considered high risk you may have different pregnancy care needs.

High-risk pregnancy | Sydney Obstetrician Dr Anu Mahadik

Who is at more risk of a high-risk pregnancy?

A high-risk pregnancy can result from a medical condition that is present before pregnancy. You are more at risk of a high-risk pregnancy if you:

  • Are over 35
  • Smoked, drank or used drugs during your pregnancy
  • Are carrying multiple fetuses
  • Have a history of pregnancy-related hypertension disorders, such as preeclampsia
  • Have a history of premature birth
  • Have health problems, such as
High-risk pregnancy obstetrician Sydney

High-risk pregnancy | Sydney Obstetrician Dr Anu Mahadik

Can you develop a high-risk pregnancy?

Yes, you may not always begin your pregnancy as high risk. A condition may develop during pregnancy that causes your pregnancy to become high risk. Complications can also develop during pregnancy, such as:

  • An abnormal placenta position
  • Fetal growth restriction (fetal growth less than the 10th percentile for gestational age)
  • Rhesus (Rh) sensitization when your immune system is attacking the baby
If you are high risk you will require special monitoring and care throughout your pregnancy. This may involve more regular appointments and additional tests. Most women with high risks pregnancies deliver a healthy baby. We will help you determine what is needed.

Twin pregnancy | Sydney Obstetrician Dr Anu Mahadik

Twin pregnancy

During a multiple pregnancy you can expect more pregnancy related symptoms including nausea & vomiting, heartburn, fatigue, varicose veins.

If you are having twins you will need more frequent checkups. This will be used to track your babies’ growth and development and monitor your own health. You will be watched closely for signs of preterm labour which is more common in multiple births. You may be sent for more frequent ultrasounds and other tests, especially as the pregnancy progresses.

You should be prepared for an earlier delivery. If you don’t then you should expect to have your birth planned before your due date either by an induction of labour or by caesarean section. The timing of birth will depend on the type of twins and any other associated pregnancy complications.

What to do if I’m having twins?

During a multiple pregnancy you can expect more pregnancy related symptoms including nausea & vomiting, heartburn, fatigue, varicose veins.
If you are having twins you will need more frequent checkups. This will be used to track your babies’ growth and development and monitor your own health. You will be watched closely for signs of preterm labour which is more common in multiple births. You may be sent for more frequent ultrasounds and other tests, especially as the pregnancy progresses.

You should be prepared for an earlier delivery. If you don’t then you should expect to have your birth planned before your due date either by an induction of labour or by caesarean section. The timing of birth will depend on the type of twins and any other associated pregnancy complications.

Complications with multiple births

If you are having multiples you need to be aware of the possible complications. This is so you can be prepared and seek medical attention if needed. Just because you are having twins (or more) does not mean you will experience these complications – healthy multiples are born every day.

During pregnancy you have an increased risk of gestational diabetes. An endocrinologist will help you manage your blood sugar levels during pregnancy. You are also more likely to develop high blood pressure. In identical twins, where they are sharing a placenta, a twin-twin transfusion may occur where one baby receives too much blood and the other too little. This is a serious complication and will need to be closely monitored by special ultrasounds performed by specialists.

Twins may be born early. This may result in complications including breathing difficulties, vision problems, infection and jaundice amongst others depending on how early they are born.

Postpartum care of twins

You may need more rest and support than you have anticipated with twins. This is especially the case the babies were born prematurely or need special medical care.
Fraternal (non-identical) twins and multiples occur when two (or more) separate eggs are fertilized by two (or more) different sperm (one sperm per egg). This means the twins do not share the same DNA and will not be identical. They can be of the same or opposite sex. Each baby will typically have their own placenta and amniotic sac. Identical twins occur when a fertilized egg splits and develops into two (or more) fetuses. They are genetically identical – they will have the same sex and share physical traits and characteristics. Rarely, identical twins will fail to completely separate and be born as conjoined twins. Identical twins can share a placenta and an amniotic sac or they might share a placenta but each have a separate sac. Triplets and higher multiples can be identical, fraternal or a combination of both!
Twin or triplet pregnancies may occur randomly by chance. In other cases they occur due to specific factors such as being older (as hormonal changes cause multiple eggs to be released) or due to the use of assisted reproductive technologies ( Such as IVF). The latter also increases the risk that you have triplets or higher multiples. There can be a family history of twins and higher order births.
Twin or higher multiples are discovered on an ultrasound. Having an early ultrasound, prior to 12 weeks will identify the type of twin pregnancy( identical or non identical). Identical twin pregnancies need to be monitored more closely with frequent ultrasound scans than non identical twin pregnancies as they could have more complications due to sharing of placenta.

The more babies that you are carrying the more likely you are to have a premature birth and not carry them to term.

If you have signs of preterm labour you would need to be carefully assessed in the hospital and you may need to be admitted and given steroid medications to speed up the development of your babies’ lungs.

This gives them the best chance if they are born early.
Depending on how preterm the labour is, you may need to be transferred to a hospital with adequate nursery support for preterm babies.

Vaginal delivery is still possible for twins. If you go into labour naturally and the first baby is in the correct (head-down) position you may be able to try and deliver vaginally. In some cases you may still need to have the second twin by a C-section if there were complications after the vaginal delivery of the first. If the first twin is not in the correct birthing position a C-section may be recommended. For higher order multiples a C-section is more common.

Depending on whether you have other complications, you may be induced earlier or have a scheduled C-Section during your third trimester.

Hypertension and pregnancy | Sydney Obstetrician Dr Anu Mahadik

Hypertension and pregnancy

Some women may have raised blood pressure during pregnancy. If this occurs after 20 weeks and associated with excess protein in your urine, it may part of complex condition called pre-eclampsia.

Some women have a higher chance of having pre-eclampsia during their pregnancy. These include:

  • Women in their first pregnancy
  • Women with pre-eclampsia in their last pregnancy
  • Women with pre-existing diabetes
  • Women with high BP prior to pregnancy
  • Women with autoimmune diseases like SLE
  • Women with kidney diseases
  • Women who are Obese (BMI > 30)
If you have pre-eclampsia, you will need a complete assessment of your health and your baby’s health. You will possibly be commenced on medications to stabilise your blood pressure. Depending on how far along you are in your pregnancy and how severe your condition is, a plan for how long to safely continue your pregnancy will be made. In severe cases, it can affect the function of your kidney, liver, clotting of blood and increases risk of seizures.

Preeclampsia can affect the placental blood vessels, the effect of which could be:

  • Fetal growth restriction
  • Reduce fluid around your baby
  • Preterm birth and the consequences of prematurity depending on how early the baby is born.
  • You will need to be admitted to the hospital
  • You will have a drip in your arm
  • You will be given medications to lower your blood pressure
  • You could be at an increased risk of having seizures and to prevent this you may be commenced on magnesium infusion (given by a drip in your arm)
  • Once your blood pressure is controlled, you will need to be delivered (If you are still pregnant)
  • You can have severe preeclampsia even after you have delivered your baby for upto a couple of weeks.
  • You are at an increased risk of having pre-eclampsia in your future pregnancy
  • Taking aspirin in a low dose (started prior to 12 weeks) may reduce the risk of having pre-eclampsia in your next pregnancy. This should be done in consultation with a specialist.

Diabetes and pregnancy | Sydney Obstetrician Dr Anu Mahadik

Diabetes and pregnancy

Women who have pre-existing diabetes can have successful and healthy pregnancies with proper planning and pre-pregnancy counselling.

Pre-pregnancy counselling will allow us to check how well your diabetes is controlled and whether your diabetes is affecting your kidneys/heart/liver/eyes

Ensuring that your blood sugars are well controlled prior to falling pregnant, ensuring that you are on medications safe for pregnancy allow for the pregnancy to have minimal problems for yourself and for your baby.

Apart from optimising your blood sugar control we recommend that you:

  • Take folic acid supplements
  • Stop smoking/alcohol
  • Take immunisations for rubella/chicken pox (if needed)
  • Take or change to Medicines suitable for pregnancy
  • Regular exercise

Well-controlled diabetes will ensure that you and your baby will have minimal complications from your condition. If your pregnancy is unplanned or if your diabetes is not well controlled, then this can increase risk of complications. This may include:

  • Miscarriage
  • Fetal anomalies
  • Fetal growth problems (growth restriction or macrosomia=big baby)
  • Preterm birth
  • Stillbirth
  • High BP (Pre-eclampsia)
  • Increased chance of
  • Infections during pregnancy
  • Increased risk of needing birth by caesarean section
  • Worsening of your diabetes (especially if it involves your eyes/kidneys)
  • Ketoacidosis (medical emergency in women with poorly controlled diabetes)
Care of your pregnancy will involve joint input from Dr Mahadik and your endocrinologists. We recommend you see us soon after your dating ultrasound scan. Your care will involve giving you a detailed and personalised pregnancy management plan on your first visit. Blood sugar home monitoring and goals of blood sugar levels recommended for pregnancy will be discussed. Your baby’s growth and development will be closely monitored with regular ultrasounds.
Most women with diabetes in pregnancy are offered a planned induction of labour between 38 to 39 weeks. The timing of this will depend on how well your diabetes is controlled, growth of the baby and other complications in your pregnancy.

Most babies of women with diabetes in pregnancy whose diabetes is well controlled have an uneventful neonatal course.

However, these babies need to be monitored for:

  • Hypoglycaemia
  • Jaundice
  • Feeding
  • Temperature control

If the birth has been difficult and complicated by shoulder dystocia (difficulty in delivery of shoulders after the head has delivered, seen commonly in macrosomic babies of women with diabetes) then the baby will need to assessed for bony/nerve injuries.

High-risk pregnancy | Sydney Obstetrician Dr Anu Mahadik

Fetal growth restriction

Fetal growth restriction is a condition when the baby does not grow to its normal weight during the pregnancy. It is defined in percentiles. When the baby’s estimated weight is less than the 10th percentile, it is considered small.

What are the causes of fetal growth restriction?

Some babies are small because they are destined to be small, that is they are normal babies. On the other hand, some babies are small because there is either a problem with the baby, placenta or the mother.

The common causes of fetal growth restriction are:

  • High blood pressure in mother
  • Type II Diabetes
  • Long term kidney problems
  • Autoimmune conditions such as lupus
  • Maternal smoking
  • Infections in the baby inside the womb
  • Congenital anomalies in the baby
  • Chromosomal/genetic problems in the baby
This is identified if the fundal height measurement lags behind the weeks of pregnancy and confirmed by ultrasound measurement of fetal weight less than the 10th centile. The measurement of baby’s abdomen(tummy) is an accurate estimate of baby’s growth. Measurement of baby’s abdominal circumference below the 10th centile also identifies growth restriction.
  • You will need ore frequent check up’s
  • You may be offered further blood tests to look for reasons as to why the baby is measuring small
  • Your baby will be closely monitored with ultrasounds
  • You may need earlier planned delivery depending on how small the baby is measuring, blood flows to the baby and the fluid around the baby.

Sydney Obstetrician Norwest and St George Private Hospitals

Consulting at Norwest and St George Private Hospitals

My consulting rooms are at Burbank Place, Norwest which is near Norwest Private Hospital. If you are preparing for your antenatal care and looking for the best and most suitable solution, you can count on my practice to help you. If you live northwest of Sydney CBD, or near the M2 or M7, you may find my practice in Norwest suitable for your antenatal care consultations.

If you live in the Sydney CBD, or south of Sydney, you may be best served by coming to my rooms in Kogarah, at St George Private Hospital Medical Suites.

I come from a family of doctors and it has always been my intuitive first choice to become an Obstetrician and Gynaecologist. I basically grew up in it, with my father being one of the co-founders of a series of IVF clinics in India. Care for mothers and the babies they are expecting has always been my first nature and I am grateful for being able to serve my patients in their journey.
So if you are in that phase where you are not sure how to choose a private obstetrician in Sydney, let’s have a chat so we can plan your antenatal care together.

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