High-Risk Pregnancy Care

Our High-Risk Pregnancy Services provide specialised care and close monitoring for pregnancies that require extra attention. With experienced specialists and advanced monitoring, we ensure the best possible outcomes for both mother and baby when complications arise or risk factors are present.

What Is a High-Risk Pregnancy?

A high-risk pregnancy is one where the mother, baby, or both have an increased chance of health problems before, during, or after delivery. This may be due to pre-existing medical conditions, complications that develop during pregnancy, or factors related to the pregnancy itself.

Having a high-risk pregnancy doesn’t mean something will go wrong — it means you need closer monitoring and specialised care to ensure the best outcome.

Risk Factors

You may be considered high-risk if you have:

Pre-existing medical conditions:

• Diabetes (Type 1 or Type 2)
• Hypertension (high blood pressure)
• Heart disease
• Kidney disease
• Autoimmune conditions (lupus, thyroid disorders)
• Blood clotting disorders
• Epilepsy
• Mental health conditions

Pregnancy-related factors:

• Multiple pregnancy (twins, triplets)
• Previous pregnancy complications
• Previous caesarean section
• Conceiving through IVF
• Abnormal placenta position
• Cervical insufficiency

Lifestyle and demographic factors:

• Maternal age over 35 (advanced maternal age)
• Maternal age under 18
• Obesity (BMI over 30)
• Underweight (BMI under 18.5)
• Smoking, alcohol, or substance use

Pre-eclampsia

What Is Pre-eclampsia?

Pre-eclampsia is a serious pregnancy condition characterised by high blood pressure and protein in the urine, usually developing after 20 weeks of pregnancy. It affects about 5-8% of pregnancies and can be life-threatening if not managed properly.

Risk Factors for Pre-eclampsia

• First pregnancy
• Previous pre-eclampsia
• Family history of pre-eclampsia
• Multiple pregnancy
• Age over 40 or under 20
• Obesity
• Pre-existing hypertension, diabetes, or kidney disease
• Autoimmune conditions
• More than 10 years since last pregnancy
• IVF pregnancy

Symptoms

Warning signs to watch for:

• Severe headache that doesn’t go away
• Visual disturbances (blurred vision, seeing spots, light sensitivity)
• Severe pain below the ribs (especially on the right)
• Sudden swelling of face, hands, or feet
• Nausea or vomiting (in second half of pregnancy)
• Feeling generally unwell

Note: Pre-eclampsia can develop without obvious symptoms, which is why regular blood pressure checks are essential.

Complications

If untreated, pre-eclampsia can lead to:

• Eclampsia (seizures)
• HELLP syndrome (liver and blood clotting disorder)
• Stroke
• Organ damage (liver, kidney)
• Placental abruption
• Preterm birth
• Fetal growth restriction

Prevention

Low-dose aspirin:

• Recommended for women at high risk
• Started from 12 weeks of pregnancy
• Reduces risk by up to 60%

Calcium supplementation:

• May be recommended if dietary calcium is low

Monitoring

• Regular blood pressure checks
• Urine tests for protein
• Blood tests to check liver and kidney function
• Ultrasound scans to monitor baby’s growth
• Doppler assessment of blood flow

Treatment

• Close monitoring (may require hospitalisation)
• Medication to lower blood pressure
• Magnesium sulphate to prevent seizures
• Corticosteroids if preterm delivery likely
• Delivery — The only cure for pre-eclampsia; timing depends on severity and gestation

Gestational Diabetes

What Is Gestational Diabetes?

Gestational diabetes is high blood sugar that develops during pregnancy and usually resolves after delivery. It occurs when the body cannot produce enough insulin to meet the extra demands of pregnancy.

Risk Factors

• BMI over 30
• Previous gestational diabetes
• Previous large baby (over 4.5 kg)
• Family history of diabetes
• South Asian, Black Caribbean, or Middle Eastern ethnicity
• Previous unexplained stillbirth
• Polycystic ovary syndrome (PCOS)

Screening

Glucose Tolerance Test (GTT):

• Offered at 24-28 weeks of pregnancy
• Earlier testing if high risk
• Fasting blood test, then drink glucose solution, then further blood tests

Why Does It Matter?

Uncontrolled gestational diabetes can cause:

For baby:

• Large baby (macrosomia) — risk of difficult delivery
• Low blood sugar after birth
• Jaundice
• Breathing problems
• Higher risk of obesity and diabetes later in life
• Stillbirth (in severe cases)

For mother:

• Increased risk of pre-eclampsia
• Difficult delivery/caesarean section
• Type 2 diabetes later in life (50% risk within 10 years)

Management

Lifestyle changes (first line):

• Dietary modifications — balanced meals, controlled carbohydrates
• Regular physical activity
• Blood sugar monitoring

Medication (if targets not met):

• Metformin tablets
• Insulin injections

Monitoring:

• Regular blood sugar checks (home monitoring)
• Growth scans to monitor baby’s size
• More frequent antenatal visits

After Delivery

• Blood sugar usually returns to normal
• GTT at 6-12 weeks postpartum to check
• Annual diabetes screening recommended
• Lifestyle advice to reduce future risk

Multiple Pregnancy

Why Is It Higher Risk?

Twin and higher-order multiple pregnancies carry increased risks:

For mother:

• Gestational diabetes
• Pre-eclampsia
• Anaemia
• Caesarean section
• Postpartum haemorrhage

For babies:

• Preterm birth (average 36 weeks for twins)
• Low birth weight
• Twin-to-twin transfusion syndrome (identical twins sharing placenta)
• Growth discordance (one twin smaller than the other)
• Congenital abnormalities

Types of Twin Pregnancy

Monitoring

• More frequent scans (every 2-4 weeks)
• Growth monitoring
• Cervical length assessment
• Screening for twin-to-twin transfusion syndrome
• Earlier delivery planning (usually 36-38 weeks)

Placental Conditions

Placenta Previa

What is it? The placenta is positioned low in the uterus, partially or completely covering the cervix.

Risks:

• Bleeding during pregnancy
• Heavy bleeding during delivery
• Caesarean section usually required

Management:

• Avoid intercourse and strenuous activity
• Hospital admission if bleeding
• Planned caesarean section (usually 36-37 weeks)

Placenta Accreta Spectrum

What is it? The placenta grows too deeply into the uterine wall and may invade surrounding organs.

Risk factors:

• Previous caesarean sections
• Placenta previa
• Previous uterine surgery

Management:

• Specialised surgical planning
• Multidisciplinary team approach
• May require hysterectomy at delivery

Placental Abruption

What is it? The placenta separates from the uterine wall before delivery.

Warning signs:

• Vaginal bleeding
• Severe abdominal pain
• Uterine tenderness
• Contractions

Management:

• Emergency situation requiring immediate medical attention
• May require emergency delivery

Previous Pregnancy Complications

If you experienced complications in a previous pregnancy, you may need closer monitoring:

Previous Pre-eclampsia

• Low-dose aspirin from 12 weeks
• More frequent blood pressure and urine checks
• Growth scans

Previous Preterm Birth

• Cervical length monitoring
• Progesterone treatment may be offered
• Cervical cerclage in some cases

Previous Gestational Diabetes

• Early glucose testing
• Lifestyle advice from early pregnancy
• Close monitoring

Previous Stillbirth

• Investigation of cause if known
• Consultant-led care
• Enhanced monitoring
• Planned timing of delivery

Previous Caesarean Section

• Discussion of delivery options (VBAC vs repeat caesarean)
• Monitoring for scar complications
• Birth planning consultation

Pre-existing Medical Conditions

Chronic Hypertension

Management:

• Medication review (some drugs not safe in pregnancy)
• Regular blood pressure monitoring
• Watch for superimposed pre-eclampsia
• Growth scans
• Planned delivery timing

Type 1 and Type 2 Diabetes

Pre-pregnancy:

• Optimise blood sugar control before conception
• Folic acid 5mg daily
• Medication review

During pregnancy:

• Tight blood sugar control
• Frequent monitoring
• Regular scans
• Consultant-led care
• Planned delivery (usually 37-38 weeks)

Thyroid Disorders

Hypothyroidism:

• Regular thyroid function tests
• Dose adjustments as pregnancy progresses

Hyperthyroidism:

• Medication adjustment
• Monitoring for fetal effects

Autoimmune Conditions

Lupus, antiphospholipid syndrome, rheumatoid arthritis:

• Pre-pregnancy counselling
• Medication review
• Low-dose aspirin
• Close monitoring for complications
• Multidisciplinary care

Blood Clotting Disorders

• Assessment of thrombosis risk
• Blood thinning medication if needed
• Compression stockings
• Monitoring throughout pregnancy

Advanced Maternal Age

Pregnancy at age 35 and over carries some additional considerations:

Increased risks:

• Chromosomal abnormalities (Down syndrome)
• Miscarriage
• Gestational diabetes
• Pre-eclampsia
• Placenta previa
• Caesarean section
• Stillbirth

Our approach:

• Genetic screening options (NIPT, combined screening)
• Regular monitoring
• Growth scans in third trimester
• Discussion of delivery timing

Our High-Risk Pregnancy Care

What We Offer

Consultant-led care:

• Direct care from specialist obstetricians
• Personalised care plans
• Accessible support throughout pregnancy

Enhanced monitoring:

• More frequent antenatal visits
• Additional ultrasound scans
• Specialised tests as needed
• Growth and wellbeing monitoring

Multidisciplinary approach:

• Collaboration with other specialists (diabetologists, cardiologists, etc.)
• Anaesthetic review when needed
• Neonatal team involvement
• Mental health support

Birth planning:

• Detailed discussion of delivery options
• Timing of delivery
• Mode of delivery
• Place of delivery
• Emergency planning

Monitoring Tools

• Ultrasound scans — Growth, fluid levels, placental function
• Doppler studies — Blood flow to baby
• CTG monitoring — Baby’s heart rate patterns
• Blood tests — Checking for complications
• Blood pressure monitoring — At every visit and home monitoring if needed

When to Seek Urgent Help

Contact us immediately or go to hospital if you experience:

• Severe headache that doesn’t go away
• Visual disturbances
• Severe swelling of face or hands
• Pain below ribs, especially on the right
• Vaginal bleeding
• Reduced baby movements
• Regular painful contractions before 37 weeks
• Waters breaking
• Severe abdominal pain
• Feeling very unwell

Frequently Asked Questions

Will I definitely have complications because I’m high-risk? No. Being high-risk means you need closer monitoring, not that problems will definitely occur. Many high-risk pregnancies proceed smoothly with appropriate care.

Can I still have a vaginal delivery? Many women with high-risk pregnancies can still deliver vaginally. This depends on your specific situation and will be discussed individually.

Will I need to deliver early? Some high-risk conditions require earlier delivery for safety. Your team will discuss optimal timing based on your circumstances.

How often will I have appointments? This varies depending on your risk factors. High-risk pregnancies typically require more frequent visits than standard antenatal care.

Can I continue working? This depends on your specific condition and type of work. We can provide advice and documentation if you need workplace adjustments.

Book a Consultation

If you have risk factors for a high-risk pregnancy or have been told your pregnancy is high-risk, our specialist team is here to provide the care you need. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.