Is my baby okay?

Eulalee Thompson

THE HEALTH staff at Kingston's busy maternity centre, the Victoria Jubilee Hospital (VJH) delivers nearly 12,000 babies every year. About 30 per cent of the pregnant women seen there each year are classified as high-risk pregnancies and must receive special medical attention.

Dr. Douglas McDonald, VJH's senior medical officer (SMO), said that a pregnancy is classified as high risk when an increased hazard is imposed on the life or health of the mother or foetus during pregnancy or after delivery.

Several factors can impose an increased hazard on the mother or foetus. Dr. McDonald, who is also an obstetrician and gynaecologist, mentioned maternal characteristics such as age, weight, past obstetric history, past medical history, a family history which relates to adverse foetal or maternal outcome, uncertainty of gestational age, as well as any abnormalities detected at the first antenatal examination (when the obstetrician would first classify the pregnancy as high or low risk).

"The aim of the risk approach is to predict problems before they arise so that women who are classified as high risk can receive special care by an obstetrician and further care in a hospital setting (if necessary). Low-risk mothers can receive antenatal care at their local health centres without specialised personnel and equipment," Dr. McDonald said.

The management of high-risk pregnancies requires a team approach. The SMO said that a paediatrician should be involved as early as possible, in all high risk cases because prematurity accounts for the largest number of perinatal deaths. In cases where early delivery is anticipated, the paediatrician should be available to assist with the resuscitation of the newborn and to care for the neonate after birth.

High-risk pregnant women are closely monitored and there is careful planning by the medical team for their delivery. They are counselled, Dr. McDonald said, so that they can gain insight into their special situations and they would be seen more frequently by their obstetricians, perhaps weekly or fortnightly rather than monthly. As the delivery date draws closer they would need to be seen even more frequently than that, he said.

"Both the mother and fetus must be closely monitored during pregnancy. Weight gain must be clearly documented, maternal conditions such as high blood pressure, anaemia, diabetes mellitus and so on must be treated aggressively. The estimated date of delivery must be established early, fetal growth must be monitored throughout the pregnancy; this can be done by measuring the uterine size at each antenatal visit, by evaluation of maternal weight gain and by ultrasound," Dr. McDonald said.

The at-risk expectant mother can also play a role in the management of her pregnancy. For example, Dr. McDonald said that she can monitor foetal activity by using a simple, inexpensive 'kick chart'. The 'kick chart' records the number of foetal movements felt over a specified period of time.

Foetal maturity, he said, must be clearly established by ultrasound (the earlier that this is done the more accurate it is likely to be). Monitoring of the foetus in labour is essential and this can be done by monitoring the foetal heart rate using electronic foetal monitoring. If this technology is not available, Dr. McDonald said that simply listening to the foetal heart rate every 15 minutes after a contraction can be substituted.

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