Timely identification of a high-risk pregnancy ensures that women who need medical care receive it in a specialized center. Ideally, a patient’s level of risk should be determined before pregnancy and assessed at each antenatal visit. Once a high level of risk is identified, appropriate treatment or surveillance, or both, should be initiated as soon as possible to improve maternal and fetal outcomes, and a specialist in maternal-fetal medicine should be involved in care.
Management is challenging and must be individualized, based on the patient’s overall health and particular risks. Not infrequently, inpatient management is required, and ethical challenges may be involved, such as a conflict between maternal and fetal health. Therefore, extensive counseling is vital to help the patient cope with any anxiety or depression, or both, that arises.8
In rare cases, a woman with a complex medical condition such as severe heart failure may consult an ObGyn about her desire to conceive. When that happens, the provider’s role consists only of counseling; the final decision about whether to proceed with childbearing lies with the patient. The same is true for women who have a lethal congenital abnormality.
In generalist practice, we can help reduce the rate of high-risk pregnancy by counseling our patients to lose weight, exercise, eat sensibly, and pay attention to other lifestyle factors under their control. We should also encourage them to plan their pregnancy and seek early and regular prenatal care. Only a few women may actually follow our advice—but that’s a few less high-risk pregnancies to worry about.
Dr. Saleh reports no financial relationships relevant to this article.