What is High Risk Pregnancy (HRP)?
A high risk pregnancy is a condition during pregnancy that threatens the health and life of the mother and/or fetus. A high risk pregnancy needs special care, follow up and management.
What are the aims of High Risk Pregnancy Clinic?
- To provide education, surveillance and management of pregnancies at risk.
- To provide Multidisciplinary Team (MDT) approach in managing the high risk pregnancies.
- To provide advanced facilities for managing and delivering the high risk pregnancies.
Who falls in the category of High Risk Pregnancy?
Pregnant women who seek consultation at our hospital are categorized under high risk. Pregnancy considering the below mentioned factors and are then enrolled in HRP clinic:
- Past obstetric outcomes like recurrent pregnancy loss, bad obstetric history, previous preterm delivery, previous still birth, previous Down’s syndrome child and neonatal death.
- Events occurring during the present pregnancy like growth restriction, tendency for premature delivery, bleeding per vaginum (placenta previa, abruptio placentae, vasa previa), leaking of liquor per vaginum (preterm premature rupture of membranes), utero-placental insufficiency, oligohydramnios, polyhydramnios.
- Medical diseases complicating pregnancy like high blood pressure ( Chronic hypertension, pre-eclampsia, gestational hypertension, chronic hypertension with superimposed pre-eclampsia), diabetes (Gestational diabetes mellitus, overt diabetes mellitus), hypothyroidism, hyperthyroidism, heart disease, liver disorders, kidney diseases, anaemia, obesity, thrombophilias, systemic lupus erythematosus, other collagen vascular diseases, rheumatoid arthritis etc.
- Infections during pregnancy like Toxoplasmosis, Rubella, CMV, Herpes, Chicken pox, Tuberculosis, HIV.
- Surgical disorders complicating pregnancy like fibroid uterus, previous history of myomectomy, previous classical caesarean section, ovarian cyst, renal and ureteric calculi, recent bariatric surgery etc.
- Extremes of age like elderly gravida and adolescent pregnancy.
- Multifetal gestations like Twins, Triplets or Quadruplets with or without associated complications.
- Special situations like pregnancy after renal transplant.
What are the Advantages of High Risk Pregnancy Clinic?
- Multidisciplinary Team (MDT) approach is followed involving the Consultant Obstetrician, HRP Clinic Coordinator, Pediatricians, Neonatologist, Radiologist, Fetal Medicine Consultant and other specialists like Physician, Endocrinologist, Cardiologist, Hematologist, Nephrologist, Rheumatologist, Gastro-enterologist etc. according to the individual case scenario.
- All specialists under one roof consulting as a team.
- A multidisciplinary team involves a range of health professionals working together to deliver comprehensive patient care.
- MDT approach has come out as a way of rendering comprehensive medical care by bringing together professionals from a broad range of disciplines in a coordinated and effective manner to upgrade maternal and neonatal outcomes.
- State of the art Labour room and NICU facilities
What are the Investigations and Services offered?
- Genetic counselling
- Pre-conceptional counselling
- Prenatal screening and diagnosis with facilities which include biochemical marker screening like double marker, quadruple marker test; advanced ultrasound for the detection of fetal anomalies like NT scan and a detailed malformation scan, fetal 2D Echo whenever required; advanced procedures like chorionic villous sampling, selective fetal reduction, amniocentesis, fetal blood sampling, intrauterine transfusion in cases of Rh isoimmunisation, fetal therapy; other special investigations like karyotype and microarray for products of conception etc.
- Regular follow up with obstetrician in OPD.
- Extensive ante-partum and intra-partum fetal surveillance.
- State of the art LDRP suites with hydrotherapy, Labour Room and well equipped Operation Theatre.
- Labour analgesia by the anaesthetists.
- Blood bank facility in case of obstetric emergencies.
- NICU with advanced neonatal care managed by neonatologist.
How do we monitor a High Risk Pregnancy?
- Monitoring includes more frequent visits to the doctor, routine blood tests, tests to monitor the medical problems, specific tests and procedures, several ultrasound examinations (routine and special) and fetal monitoring.
- These tests and investigations are designed to track the condition of mother and fetus.
How does High Risk Pregnancy differ from normal pregnancy?
- Frequent antenatal visits
- Close monitoring of maternal and fetal well being
- Special investigations (other than the routine ) and management of risk factors
- Multidisciplinary Team Approach
How do we improve our maternal and fetal outcomes in High Risk Pregnancy Clinic?
- Use of tools like Diet charts/ hand-outs for patients
- Best practice protocols-evidence based
- Improve outcomes by Standard Operating procedures, Pathway, Multidisciplinary Team approach, Training the students and staff adequately
- Safety checklist
- Complete documentation
- Ensure continuity of care after discharge
- Simulation programs
- Continuing Medical Education (CMEs)
- Clinical Audit is a process of quality improvement that seeks to enhance patient care and outcomes
We have many success stories till date and wish to continue the good work and aim to optimize our maternal and fetal outcomes!
About the Author
Dr. Anita Soni is a practicing doctor at the well-renowned Dr. L H Hiranandani Hospital, Mumbai, practicing as a full time Consultant Obstetrician and Gynecologist. She has worked at the hospital since its inception in 2004. Dr. Soni is an expert in the field with the academic excellence as an MD, DNB, FCPS, DGO, and FICOG. She has special interest in the areas of High Risk Pregnancies, Gynecological Surgeries, Ultra Sonography, and Maternal Fetal Medicine. Today, there are a number of national and international publications to her credit.