Pregnancy is a normal and natural period for most women. However, in some cases the diseases
in the expectant mother's body or situations caused by pregnancy may constitute risk.
Risk is normal in pregnancy, as it is in all parts of life. In various cases, the diseases present in
the expectant mother's body prior to pregnancy or problems that are caused by pregnancy, that
occur during the pregnancy period may cause risks. Such pregnancies are defined as risky or
high risk pregnancy.

Which Problems should be assessed as High Risk Factor?
Problems that may cause high risk in pregnancy arise in approximately 6 to 8% of all
If the expectant mother is below the age of 18 or over the age of 35, if she is underweight or
overweight, if the expectant mother and father are blood relatives, if the expectant mother is on
any medication, if she smokes or consumes alcohol and if there is a recurring history of
miscarriages, the risk factor increases.
The problems that cause risk factors may be pre-existing and may be discovered during
pregnancy. Certain cases are special to pregnancy and only occur during continuing pregnancy
and create risk for mother and infant.

Which Diseases Negatively Impact Pregnancy?
Immune system diseases, blood diseases, diabetes, genetic diseases, cardiovascular diseases,
hypertension, infection, kidney diseases, lung diseases, liver diseases, neurological problems and
thyroid diseases constitute risk factors in pregnancy by negatively impacting expectant mothers.
Pre-conception doctor's examination is especially important for women with diabetes. Similarly,
hypertension and cardiovascular diseases are also problems that may cause high risk in
pregnancy. Mothers-to- be should be assessed by relevant medical departments prior to
conception, especially for said diseases, and follow-ups should be carried out during pregnancy.

What are some of the problems that may arise during pregnancy?
Pre-eclampsia and Eclampsia:
Pre-eclampsia and Eclampsia, pregnancy induced hypertension and other systemic findings,
known publicly as "toxemia of pregnancy" are among the cases that require most attention
during pregnancy.
Pre-eclampsia is extremely risk and the expectant mother has hypertension, wide-spread
edema and protein in the urine. This is observed only during the pregnancy and shows an
instant and quick recovery after the end of pregnancy. In more severe cases, liver failure and
hemophilia are observed, risking the life of the expectant mother. Pre-eclampsia is observed in
approximately 5% of all pregnant women and generally occurs during the last trimester. Its only
definite treatment is the termination of pregnancy that is, birthing of the baby.
In Eclampsia, in addition to all this, seizures similar to epileptic seizures are observed in
expectant mothers.
Gestational Diabetes
Another health problem that may arise during pregnancy is diabetes. Presence of diabetes in the
mother may cause the baby to develop larger than normal. Such infants are defined as
macrosomic and are under high-risk in terms of neonatal problems.
It is not possible to prevent gestational diabetes, however, it is possible to diagnose early to
appropriately monitor and decrease the risk for mother and baby.
Infections can cause high risk in pregnancy. Common infections such as cold are not usually high
risk creators in terms of the mother or infant. However, parvovirus infections, toxoplasma,
rubella and such infections, although rare, may negatively impact the developing fetus.
Checking for a history of rubella prior to pregnancy and protection via vaccination remove major
risk of infection to a general extent. Toxoplasma may be avoided by taking simple precautions
such as refraining from eating raw or rare meat, washing raw salads well and not changing cat
litter, if any. Toxoplasma infection may cause early miscarriages, stillbirth or permanent
anomalies in the infant. Other factors that may cause premature birth are urinary tract or
vaginal infections.

Among infections, group B streptococcus (GBS) is especially significant. This bacteria exists in
the intestines and vagina of most women. This bacteria may not cause any problems for the
mother but may infect the baby during birth and cause serious problems. Expectant mothers
should be scanned for GBS as they near the end of their term and must be treated if found
What are Pregnancy Related Problems?
A majority of pregnancy related problems are related to the placenta. Placenta is a temporary
organ that allows for the nutrition and oxygen exchange between the mother and fetus during
the pregnancy. It is publicly known as afterbirth or water bag.
When the placenta settles to cover the cervix partially or completely at the bottom of the uterus,
it is called placenta previa and is observed in approximately 3% of pregnancies. This makes
natural birth impossible and requires caesarian section. Placenta previa may cause heavy
bleeding, especially during the last trimester and may endanger the mother's as well as the
baby's life. It is easy to detect placenta previa with ultrasound. In such a case, the pregnant
woman must be closely monitored for bleeding.
Another important health problem with newborns is prematurity and low birth weight due to
premature birth. While the mechanisms that trigger premature birth are not completely known,
certain infections and multiple pregnancies create risk factors. Cramps and spasms that occur
regularly and small amount of water may be signs of premature birth, and thus, must be taken
into serious consideration.
What are the Problems that may be observed in the baby?
Congenital anomaly, maldevelopment, erythroblastosis fetalis and multiple pregnancies may be
considered among such problems.
Approximately 5% of pregnancies show congenital anomaly. These anomalies may be simple
problems or serious life threatening ones; some may even be genetically transitioned. Therefore,
if mothers or fathers to be or their families have a known genetic disorder, the ideal precaution
to take would be to receive genetic consultancy prior to birth.
Certain blood tests and ultrasound observations during pregnancy may be used to determine
various anomalies, especially Down Syndrome. However, it must be taken into account that the
ultrasound may be insufficient in determining all anomalies.
Special attention is required when the fetus is too big or too small (retarded development).
These may be symptoms of diabetes or hypertension. Similarly, too much or too little amniotic
fluid may be a sign for danger.

It is Essential to Monitor High Risk Pregnancies
-In high risk pregnancies, if there is an underlying disease, the primary concern should be to
treat this disease. Further inspections such as amniocentesis, cordocentesis or placentacentesis
may be applied, depending on the expectant mother's situation. Frequent blood and urine tests
and examination and ultrasound may also be necessary, depending on the type of risk cause.
Risky and high risk pregnancies may go beyond posing a threat to the expectant mother's and
the fetus' health and cause serious life risk. Thus, risky and/or high risk pregnancies must be
monitored by perinatologists.

Prof. Dr. Zehra Neşe KAVAK

Gynecology, Obstetrics and Perinatology

Academic Hospital