Not all pregnancies are necessarily straightforward and uncomplicated. At the first antenatal visit a comprehensive history will be documented and will alert Dr Hatzikostas to specific high-risk areas of concern. It may become apparent that an individual patient has a family history of a medical condition that can adversely affect the pregnancy. A previous poor past obstetric history will necessitate special care. Each of these areas requires specific targeted treatment to reduce the risk of complications and improve pregnancy outcomes. Quite often patients may not have any abnormal history but as the pregnancy progresses problems may develop and will require specialised complex care.
Problems that can occur include:
- Recurrent Miscarriages
- Cervical incompetence
- Intrauterine growth restriction
- Gestational diabetes
- Thyroid disease in pregnancy
- Hypertensive diseases in pregnancy
- Blood clotting disorders
- Antepartum haemorrhages
- Twin pregnancies
- Breech presentations
- Fetal abnormalities
Habitual miscarriage is defined whenever any woman has had three consecutive miscarriages. Recurrent miscarriage is a distressing condition for all affected women.There are potential treatment options and all such women need to be investigated.
Cervical incompetence and Cervical suture
Cervical incompetence is a serious condition and is caused by weakness of the cervix, which painlessly shortens and dilates in the second trimester. This can result in recurrent mid trimester pregnancy loss. Your Obstetrician needs to be aware of pre existing risk factors and ideally should start appropriate treatment before your cervix shortens.
Intrauterine growth restrictions
Not all small babies are growth restricted. Some babies are healthy and constitutionally small. Some babies are small because of an adverse effect such as intra uterine infection or exposure to some toxin early in pregnancy. Most babies who have intrauterine growth restriction will do so because of placental insufficiency. Small babies need very close monitoring.
Diabetes in pregnancy
Diabetes is a common medical condition in pregnancy and affects approximately 1 in 6 pregnancies. Diabetes has the potential to cause serious effects on fetal well being in utero. Diabetes needs to be diagnosed early, monitored closely, and treated appropriately.
Thyroid disease in pregnancy
Abnormalities of thyroid function are common in pregnancy and screening of thyroid function is now routine practice.
Hypertensive diseases in pregnancy
Hypertension is one of the most important and serious conditions in pregnancy. Hypertension can proceed to a more serious condition pre eclampsia. Both hypertension and pre eclampsia can have very serious effects on both mother and baby. Pre eclampsia requires diagnosis, stabilization and treatment and invariably results in earlier delivery of the baby.
Maternal blood clotting disorders (Thrombophilias)
Healthy pregnancies require normal placental blood flow. Thrombophilia’s are associated with an increased risk of blood clotting Thrombophilia’s can adversely affect placental blood flow and increase fetal risks.
Antepartum haemorrhages are identified as bleeding in pregnancy occurring after the 20th week of pregnancy. They are associated with major risks to mother and baby’s health.
Multiple pregnancy – Non identical and Identical twins
Multiple pregnancies can be exciting but they are associated with more problems and require close supervision. With multiple pregnancies we are usually referring to Twins. Higher order multiples such as triplets are far less common.
It has long been recognised that breech presentations are associated with increased risks both antenatally and especially at vaginal delivery. Although breech presentations account for only 3% of all pregnancies they have historically accounted for much more perinatal mortality and morbidity. Attempts at vaginal breech delivery can be associated with serious complications for the baby at the last moment of delivery. The consensus agreement today is that these pregnancies should be delivered by elective caesarean section.
There are multiple causes for fetal anomalies. There are measures that we can take to reduce the frequency of fetal anomalies. Tests are available to assess if the fetus is normal. When an anomaly is found a team of specialists will be required in further management. Patients need to be well informed about the significance of the anomaly and the potential impact on their child’s life.