High-risk pregnancy – what causes it?

High-risk pregnancy – causes

The risk is highest in the first few weeks of pregnancy. The risk of miscarriage is also highest during this time. Pregnancy loss is most frequently caused by genetic defects in the baby. Other causes are anatomical abnormalities of the uterus that prevent normal development of the pregnancy, such as uterine septum or fibroids (mainly submucosal). A dysfunction of the corpus luteum and an insufficient level of progesterone in the woman’s body can also be causes of miscarriages. However, it is not an inevitable consequence that the pregnancy will definitely end in a miscarriage in such a situation. In gynaecology and obstetrics, this is differentiated by the term ‘threatened miscarriage’. This is a situation in which there are symptoms that indicate a miscarriage, such as bleeding from the genital tract or slight pain in the lower abdomen, but no miscarriage has occurred, i.e. the pregnancy continues.

High-risk pregnancy – risk factors

The risk factors for a high-risk pregnancy include:

• previous miscarriages
• intrauterine adhesions
• Cervical insufficiency in previous pregnancies
• Uterine myomas
• Minor pelvic endometriosis
• proven thrombophilia

Women with chronic illnesses such as high blood pressure or obesity also have a higher risk of a high-risk pregnancy. The risk of possible pregnancy complications also increases with the age of the expectant mother.

High-risk pregnancy – treatment

The treatment of high-risk pregnancies is unfortunately quite limited. If the cause is a disruption of the luteal phase, progesterone supplementation is recommended. However, the effectiveness of progesterone supplementation in high-risk pregnancies is controversial among experts. In high-risk pregnancies, it is extremely important to rest and avoid stressful situations.

If the pregnancy is at risk due to a so-called cervical insufficiency, a so-called cervical suture is used in addition to progesterone. If, on the other hand, premature dilation of the cervix occurs, the woman is given a rescue suture. In the case of frequent miscarriages (at least 3), it is very important to look for the cause. They are often caused by antiphospholipid syndrome. If it is diagnosed, treatment consists of the expectant mother taking acetylsalicylic acid and low-molecular-weight heparin.

Nowadays, doctors advise against bed rest for high-risk pregnancies, as it increases the risk of thromboembolism and can lead to a pulmonary embolism.