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High-risk pregnancies occur in less than 10 percent of all pregnancies in the U.S., but the complications for mother and baby can be serious, including preeclampsia, preterm delivery, miscarriage or stillbirth. Among the most common reasons for high-risk pregnancy are older age of the mother, pre-existing health problems in the mother, previous pregnancy complications, pregnancy with multiples and problems in the developing baby. The key to good outcomes for mother and baby, experts say, is teamwork.
"More women are waiting until later in life to have children, and their increased age may also increase their risk for complications during pregnancy," says UCLA maternal and fetal medicine specialist Daniel Kahn, M.D., Ph.D., who adds that a greater number of women are now seeking consultations with high-risk pregnancy experts. "With advanced, collaborative care from many specialists, we are able to take these women successfully through their pregnancies, with excellent outcomes for mother and baby."
According to Dr. Kahn, that collaboration begins as soon as there is any reason to suspect a problem in the mother or fetus. When the mother has a pre-existing health condition - such as heart disease, high blood pressure, diabetes or an autoimmune disorder - coordination of care with an appropriate subspecialist is required. When a congenital malformation is detected while the fetus is still in the womb, careful monitoring is critical to the survival of the fetus.
"Our magic at UCLA is that we have under one roof a complete team of subspecialists ready to address any issues necessary to protect and promote the health of mother and child," Dr. Kahn says.
"We definitely get involved in the earlier stages of planning a high-risk delivery," says Richard Hong, M.D., chief of obstetric anesthesiology at Ronald Reagan UCLA Medical Center. Anesthesia during delivery is generally well tolerated for most young, healthy women. Certain maternal diseases, however, increase the risk for complications and require additional monitoring.
"It's not cut and dry," Dr. Hong says. "Sometimes we have to adjust our techniques after discussing the risks and benefits with the patient and the entire health team." At UCLA, obstetricians and obstetric anesthesiologists are always available in house.
An early assessment of the risks associated with the delivery may also impact when and where the mother delivers.
"Once a high-risk pregnancy is identified, we begin receiving reports regarding the status of the mother and progression of the pregnancy," explains Nancy Sanchez, director of Women's and Children's Services at UCLA Medical Center, Santa Monica. UCLA has designated rooms where high-risk mothers stay on strict bed rest until delivery at 32 to 36 weeks, Sanchez says. Mothers receive continuous monitoring by nursing staff and are given medications and other appropriate treatment to prevent or delay preterm birth. Additionally, members of the neonatal intensive care unit (NICU) visit the expecting parents to discuss care for their baby after delivery. The labor and delivery and NICU staff work together to help parents to connect with their babies as soon as possible once the newborn is stabilized.
"Communication is everything," Sanchez says. "It not only leads to better outcomes, it also helps to alleviate the fears of parents that may be feeling overwhelmed."