High-Risk Pregnancies

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Author: Lisa Joels

20 Nov, 2020

Approaching High Risk Pregnancies Appropriately

There are many factors that can make a pregnancy high risk, including existing health conditions, your age, lifestyle, and health issues, including those that that happen before pregnancy but also some that happen during pregnancy.

Whereas the majority of high-risk pregnancies and births go without complication, in part that is because of the careful approaches and protocols adopted to ensure that the risk factors are appropriately addressed. It also means ensuring that you have just the right backup ready to be engaged if needed.

What is a high-risk pregnancy?

Quite simply, it is any pregnancy where there is a greater than normal chance of complications for either Mum or the baby. There are many factors that can predispose a pregnancy to risk. The following is not designed to be fully comprehensive but certainly covers the main ones.

Existing Health Conditions

  • High blood pressure
  • Polycystic ovary syndrome (PCOS)
  • Diabetes
  • Kidney disease
  • Autoimmune disease
  • Thyroid disease
  • Obesity
  • Certain infections e.g. Zika

Life Decisions & Lifestyle

  • First pregnancy after age 35
  • Alcohol use
  • Tobacco use
  • Drug use

Conditions of Pregnancy

  • Multiple gestation
  • Gestational diabetes
  • Preeclampsia and eclampsia
  • Previous preterm birth
  • Birth defects or genetic conditions

First pregnancy after age 35

With busy lives and careers, this is perhaps one of the more common reasons for a pregnancy to be higher risk. Most pregnancies to older first-time mothers are normal but there are heightened risks of the following:

  • Pregnancy-related high blood pressure (called gestational hypertension)
  • Diabetes (called gestational diabetes)
  • Pregnancy loss
  • Ectopic pregnancy (when the embryo attaches itself outside the uterus)
  • Caesarean delivery
  • Delivery complications, such as excessive bleeding
  • Prolonged labour (lasting more than 20 hours), or labour that does not advance
  • Genetic disorders in the baby e.g. Downs Syndrome

Consequently, these are pregnancies and deliveries where we want to adopt a heightened vigilance and ensure there are plans in place to manage any specific risks.

Gestational Diabetes

Gestational diabetes is diabetes that is diagnosed for the first time during pregnancy. The good news is that it normally reverts after pregnancy. However, it can lead to sometimes serious complications during pregnancy and delivery and as such needs careful management and birth planning, with heightened coordination between obstetrician and neonatologist. Some of the complications include:

  • Excessive birth weight, requiring a caesarean section delivery
  • Early (preterm) birth, requiring baby to be admitted to NICU under a neonatologist
  • Serious breathing difficulties, requiring immediate attention from a neonatologist
  • Low blood sugar (hypoglycemia), sometimes requiring specific support for your baby
  • Obesity and type 2 diabetes later in life, for mum
  • Stillbirth, an occasional complication of poorly managed gestational diabetes

Gestational diabetes is very common in Cayman Islands, especially in mums of Caribbean origin. At Integra, we will always monitor closely for it so that we can ensure it is managed well during pregnancy and plan birthing arrangements to ensure everything goes smoothly and safely.

The OBGYN Perspective

As an OBGYN with 34 years of experience in UK tertiary centres, you could say I have managed my fair share of high-risk pregnancies. In the UK, these pregnancies tend to be managed in specific ways under the careful supervision of individuals with expertise in them, in a multidisciplinary way. On an island, this is even more important because of the difficulties of gaining access to emergency support. The right experience and the right team count.

Besides my own high risk obstetric experience, as well as specific training including MOET (Management of Obstetric Emergencies and Trauma), I am fortunate to also have the support of the only neonatal-accredited, tertiary trained and experienced newborn paediatric team on Island, led by Dr Sara Watkin. My tertiary consultant experience from UK and her background as a UK tertiary neonatal consultant (and Chief of Service) in one of the UK’s premier centres for preterm and complex newborn care ensures that we are able to provide a true multidisciplinary approach, as well as the reassurance that your and your baby’s safety is foremost, and seamlessly managed as a team.

Integra Healthcare’s High-Risk Pregnancy Service

The Integra Obstetric-Neonatal team collectively represents decades of consultant-level, tertiary experience in managing both high risk pregnancies and the fetal or newborn complications that can arise. It is quite simple unique on Island:

  • Only combined Obstetric-Neonatal team, allowing a true, seamless, multidisciplinary approach
  • Only team with both obstetric and neonatal accredited and experienced tertiary consultants
  • Detailed fetal anomaly scans conducted by a highly experience sonographer and independently reported
  • All key obstetric and neonatal team members live within 5 minutes of Cayman Islands Hospital in George Town
  • 24/7 access to the team for concerns or urgent care issues

Based on our combined experience of literally thousands of high-risk pregnancies, here and in the UK, our approach is comprehensive, designed to assess all risk factors, proactive and multidisciplinary. We’d be delighted to talk through that approach in detail, without charge, so that you can understand just why it is unique, as well as meet the team members who might be involved.

Obstetric Services

  • Pre-conception care, including advice about pre-existing medical conditions prior to pregnancy
  • Holistic antenatal care including screening for complications of pregnancy, monitoring fetal growth and more
  • Management of pregnancy related conditions and complications
  • Joint decision making regarding birth plans
  • Intrapartum care, including active management of labour
  • Normal vaginal delivery, instrumental delivery & forceps delivery
  • Repair of perineal tears or episiotomy
  • Caesarean sections both as a planned procedure and as an emergency if complications arise
  • Management of delivery of placenta and bleeding after delivery
  • Postnatal care until discharged home & thereafter

Clinic Times

Our clinic is located in beautiful Grand pavilion, with a relaxing waiting room, complete with complementary refreshments, and plenty of onsite patient parking.

  • Monday to Friday: 8.30am first appointment, 4.30pm last appointment
  • Saturday: 8.30am first appointment, 12.30pm last appointment

We also pride ourselves on being available for our patients and parents. Outside of these hours, please see our urgent care section to know how to contact us.

Meet Our Obstetrician

Dr Lisa Joels

Dr Lisa Joels

Obstetrician & Gynaecologist

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