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Children's Care
When Pregnancy is High-RiskHow one family came through it, with help from a specialized team “We’re so happy we’re a complete family now”Brandi Wroten and her husband, Jim (shown at right with sons Skylar and Nicholas), survived a difficult pregnancy with lots of support. They took care of each other and relied on an expert medical team including maternal fetal specialists and nurses. “Everyone we trusted was right there in one hospital,” Brandi says.How to Recognize a ProblemIf you are pregnant and have any of these signs, call your obstetrician:Your baby moves less than yesterday. “Some babies naturally move more than others,” says maternal fetal specialist William Roberts, M.D. “But moving a lot one day and not much the next may signal a problem.” You have low back pain, abdominal pressure, a change in vaginal discharge or bleeding. These signs of labor are especially dangerous before 23 weeks. You’re swollen and suddenly gaining more than 5 pounds a week. This indicates preeclampsia (high blood pressure), a dangerous condition most common in teenagers and women over 35 having their first child. You’re always thirsty, urinate excessively or have blurred vision. These are signs of gestational (pregnancy-related) diabetes, a condition that raises the risk for birth defects and affects about 3 in 100 women. Your risk is higher if diabetes is in your family. Through a partnership arrangement, the couple’s local obstetrician had a maternal fetal (high-risk childbirth) specialist at Lehigh Valley Health Network read the ultrasound. In a follow-up level II ultrasound, he explored the baby’s anatomy and organ function. The diagnosis: hydrocephalus, or water on the brain. “I was so afraid,” Wroten says. “But the doctor explained everything and came up with a plan.” First, he used amniocentesis to diagnose the cause of the problem—a structural defect in the baby’s brain. Then he assembled the team Wroten would need on the big day. A maternal fetal specialist would perform a Cesarean section, since the baby’s head was too large for vaginal delivery. A neonatologist (specialist in ill newborns) and neurosurgeon would be on hand. The team monitored Wroten monthly and was ready when her contractions started early. When little Skylar was born Aug. 30, neonatologist Wendy Kowalski, M.D., discovered a new complication — a hole between Skylar’s esophagus and airway that would allow food into his lungs. “We were prepared for this,” Kowalski says. “One birth defect raises the risk for others.” Skylar was rushed into surgery for a temporary feeding tube. Later, pediatric surgeon Chris Chang, M.D., closed the esophageal hole, and neurosurgeon Mark Li, M.D., inserted a shunt (tube) to drain fluid from the baby’s brain. In two weeks, Skylar was feeding naturally and ready to go home. “Within a month, he was rolling over and raising his head, a great sign for his development,” Wroten says. Preventing pregnancy troubleAs much as we all want a healthy birth, high-risk pregnancies are a reality for one in five couples. About 20 percent of the time, the problem is a pre-existing condition in the mother, such as diabetes or heart disease. In other cases, complications arise during the pregnancy—for example, we discover multiple babies or a birth defect, or the mother develops diabetes or goes into early labor.If you’re planning a family, you can reduce your risk for complications if you: Talk with your obstetrician or family physician beforehand to lay the groundwork for a healthy pregnancy. Visit your doctor in the first trimester. You’ll be tested for anemia, diabetes, thyroid problems, bacterial infections and high blood pressure. The earlier the treatment, the better the chance of a healthy outcome. Ask your doctor about a level II ultrasound. Done with a maternal fetal specialist in the room, it’s the most advanced way to detect problems. If you have a pre-existing health condition, see a maternal fetal specialist before getting pregnant.
Want to Know More about how to cope with a high-risk pregnancy? Neonatologist Wendy Kowalski, M.D., who’s had three of them herself, offers advice .
This page last updated 10/21/08 06:21 PM
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