The term risky pregnancy refers to pregnancies that carry vital risks for the mother and the baby when left to their natural course. The main purpose of all routine monthly, sometimes more frequent pregnancy checks is to identify risky pregnancies and to combat problems that may occur or may occur.

Studies in this field have been the most important occupation of obstetricians from history to the present. Today, with the developing information technology, new methods are used in the recognition, monitoring and treatment of risky pregnancies. With these developments, maternal and infant deaths (mortality) and maternal-infant sequelae (morbidity) have been considerably reduced in the last 20 years.

Risky pregnancies have two dimensions as risks arising from the mother and risks arising from the fetus. However, the mother and the fetus are in such a close relationship that the risks for one carry a high risk for the other during pregnancy.

Risks Caused by the Mother: Pregnancy is an additional physical and mental burden for the expectant mother. For this reason, while men can have children at the age of 70, the fertility of women disappears after the age of 40. Because even with today’s technological opportunities, if 50-60 years old women could get pregnant, most of them would die; Risks arising from the mother are divided into those that exist before pregnancy and those that develop during pregnancy;

1-Pre-Pregnancy Risks:

-Mother Age: The ideal gestational age is considered to be between the ages of 20-30. Although the boundaries are forced by the developing technology, pregnancies under the age of 18 and over the age of 35 carry a high risk. With age, the frequency of genetic diseases increases, exposure to chronic diseases increases, and the mother’s resistance to the increase in physical load that may occur during pregnancy decreases. As mothers under the age of 18 do not complete their physical and mental development, they experience pregnancy risks more intensely.
-High Blood Pressure in the Mother:Mothers with high blood pressure are more prone to problems related to the load on the cardiovascular systems during pregnancy. Moreover, when pregnancy is complicated by blood pressure, it can cause vital problems for both the mother and the baby.
-Mother’s heart rhythm disorder:Some heart rhythm disorders may become evident during pregnancy with increased physical activity or may become evident during pregnancy.
– Diabetes in the mother:While diabetes can prevent conception, the impaired metabolism of the mother during pregnancy both creates an additional burden for the mother and increases the frequency of structural anomalies in the fetus, and may cause many problems for the babies during and after delivery.
-The mother has severe anemia or congenital blood diseases,
– Other system diseases in the mother (heart, kidney, rheumatic, etc.)
– Extremely thin (under 50 kg) overweight women (who are classified as obese according to their body mass index)
-Alcohol, cigarettes in the mother (it has not been proven that smoking causes anomaly in the baby, but one thing is for sure; babies of mothers who smoke have low birth weight and are born prematurely. Therefore, mothers should quit smoking during pregnancy if possible, they should consume as few cigarettes as possible if they cannot stop) or medication women who are addicted, or who use chronic medication because of their illness.
– Pregnancy with fibroids, Here, the size of the uterine fibroid and its relationship with the baby’s partner are very important.

B- Risks that may develop during pregnancy;

One of the most important goals of pregnancy follow-ups is to recognize pregnancy-induced blood pressure early, to detect who may be premature, and to take possible precautions for both mother and baby, and to manage the course of pregnancy and delivery close to perfection. In this regard, it is now possible to use very advanced technologies to determine who can develop 90% of the time, and to guide both the mother and the fetus to minimally overcome possible problems.

Gestational Diabetes: Today, especially in our country, gestational diabetes screening and follow-up, which is very controversial, is recommended both by scientific authorities all over the world and by the World Health Organization in risky pregnancy follow-ups. It occurs after 24 weeks of pregnancy (gestational sugar is not seen from the first week of pregnancy because the hormone called “human placental lactogen”HPL secreted from the placenta from the 24th week of pregnancy can cause gestational diabetes in some predisposed mothers, and this hormone may have an active effect after the 24th week. If gestational diabetes is not screened and followed well, the babies of these mothers are at higher risk of premature birth, large baby and its birth complications, sudden infant death and gestational hypertension, and these babies are more likely to encounter some metabolic problems after their birth.
Multiple Pregnancies: Multiple pregnancies are high-risk pregnancies on their own, and risks and problems increase as the number of babies increases. Generally, the increasing physical load for the mother and the problems caused by the pressure of the mother’s organs due to the fact that more than one baby takes up space in the abdomen are common. In addition, identical twins or monogamous twin babies can steal blood from each other and endanger the lives of both babies. For the diagnosis of this condition, the structure of multiple pregnancies should be revealed in the first 3 months of pregnancy. For this reason, multiple pregnancies are at a significant risk from the first week of pregnancy to the delivery and end of delivery, and they should be followed closely, and early diagnosis and management of problems are very important.
Pregnancy-related forms of some rheumatic diseases.
-Premature discharge of the mother’s waters: It can cause problems from infection in babies to widespread sepsis in the mother and respiratory distress in the baby. Mothers should be sensitive about this issue, and they should report such complaints to their doctor, even if they are mild. team almost has to play chess, early diagnosis and proper management of the process are vital. It is vital for all pregnant women to be very sensitive about this issue and to warn their physicians early.
-The baby’s wife’s blocking the birth path. Here, the importance of ultrasound is very important. It can only be understood by ultrasound during pregnancy, and women who have never had an ultrasound during their pregnancy can sometimes lose their babies and their lives under emergency conditions, even in today’s Istanbul. Its diagnosis is very easy, but the problems it may cause can go as far as loss of life. The births in which the placenta closes the birth ways (necessarily cesarean delivery) are pregnancies and deliveries with special features and must be performed in full-fledged hospitals and under the supervision of experienced physicians.
-Congenital defects in the womb. It can cause some problems from miscarriage to premature births, extremity defects in the fetus. With advanced ultrasound technology and surgical methods, such problems can be detected and resolved before pregnancy occurs. One of the most important benefits of being examined by the obstetrician before becoming pregnant is to lay the groundwork for the elimination of such problems before pregnancy.
Those who have had previous cesarean section or other uterine surgery. This group of pregnancies is at risk for uterine rupture. Meticulous follow-up and timely birth planning should be done.
-One of the most important risk criteria is the premature deletion of the birth canal, which we call “cervical insufficiency” in the mother, and as a result, screening of this severe picture, which can range from premature birth and preterm risks to fetal loss, to detect risky mothers with uterine length measurement or to detect risky mothers in previous pregnancies. Pregnancy of mothers who gave birth prematurely is included in the risky pregnancy class that requires special monitoring.

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