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So, when we think about what makes a woman high risk
again we typically divide it into a maternal indication
or a fetal indication or sometimes it's the maternal-fetal pair indication.
So, thinking about maternal indications... anytime a woman has an
underlying medical condition...people often know about high blood pressure, diabetes but it could be
asthma, a seizure disorder, a thyroid disorder,
prior history of a corrected heart problem, you know, renal disease, kidney disease,
anything...
any underlying medical problem - that qualifies a patient for high-risk. Now
within that we kind of stratify patients in terms of
high-risk-high-risk or low-risk-high-risk and we can make plans accordingly.
Again, any mother issue. The other issues that can come from the maternal
side is if they've had a prior
poor obstetrical outcome or a prior adverse outcome.
Examples of that could be a woman who delivered a baby at say
nineteen weeks gestation. That's a time when unfortunately a fetus can't survive
and so that really ends as a miscarriage and there are many reasons why that sometimes can
happen, so that's a woman that would be high-risk.
Say it's a woman who doesn't have high blood pressure but she developed something
called preeclamsia, which is the high blood pressure that's unique to pregnancy
in a prior pregnancy...
she too then can be high-risk. Those are just examples.
One real common one is gestational diabetes. Every pregnant woman is
at risk for gestational diabetes and everybody gets screened for that.
Now, in terms of the fetal indications...fetal indications typically can be a
chromosomal problem...people often know about Down syndrome but there
are many other chromosomal problems, a structural anomaly with the fetus so when
we're doing ultrasound we can detect intra cranial abnormality, cardiac
abnormality, renal abnormality,
bowel, pretty much any organ system that we can see by ultrasound we can and have found
abnormalities in those areas and if that's found, that doesn't mean the pregnancy
can't go forward,
doesn't mean the mom can't have a vaginal delivery, doesn't mean a mom can't deliver at
term, but it does mean that to optimize outcome of that baby we want to make sure we have
all the resources available at the time of delivery
to make sure, again that outcome is optimized. So, that would be a high risk pregnancy.
And then we get this mother-fetal pair, you know, there's something going on
with both.
An example: sometimes some of the chromosomal problems can have
implications for the mother
and so that pair then becomes high-risk. That's just one example.
How do we diagnose problems that
you know, would make a patient become our patient? So often, with ultrasound.
So, most patients when they come to our center they are low-risk.
They're coming to make sure everything is okay. Some people may not even understand
exactly what's going to happen here...they think they're coming to know whether they're
having a boy or girl, so with ultrasound
we essentially...I always describe to patients, "We're looking from head to toe"
and what we're looking for again are structural abnormalities
that may require their baby to need special attention at the time of delivery.
There are other structural abnormalities that may
group together and make us more concerned
about a genetic abnormality, whether it's a chromosomal or non-chromosomal genetic
abnormality,
we're looking for signs of that. I would share, and I think
with patients it's important for everyone to understand that ultrasound's not 100%.
You know, ultrasound doesn't speak to how smart your baby's going to be or
anything like that. It's really looking at structure. That's all it's really doing.
We know though from
our experience that some of these structures, if they're abnormal, can lend and
lead itself to other diagnoses so that's what we're looking for. Other
things they can come up that we're looking for...has nothing to with
ultrasound at all...
sometimes it's something - a mom has a condition that also may relate to another
condition so
a mom presents with say, diabetes, we know diabetes can affect many organ systems...
the heart, the kidneys,
the eyes, so we do additional testing to see, how's everything else going.
We may actually identify another organ system that's affected and that may have
other implications for the pregnancy.
An example of that...if we go forward with the diabetes...if we find diabetes that actually
is also affecting the kidneys
we know pregnancies where mom has diabetes and also kidney
disease...they're at higher risk of having a preterm baby, they're at higher risk of preeclampsia,
which is the high blood pressure can occur with pregnancy
They're at higher risk
for developing fetuses that don't grow appropriately and that will then lead
us to additional testing.
So, we consider ourselves to be kind of investigators
and people I think often always wonder like, how do they figure that out, but it's
just because we know
how things group together and how that grouping could have implications for
pregnancy prognosis.