Spokane-area hospitals and physicians say advancements in medicine and technology have helped reduce some of the hazards of high-risk pregnancies for both mother and baby.
Thats a good thing because high-risk pregnancies appear to be on the rise here and nationwide. Today, hospitals here estimate that 30 percent of all the pregnancies they handle are high risk, which means the mother or baby suffers from a condition or series of complications that could have serious consequences for either or both, including high-blood pressure, diabetes, birth defects, and in rare casesdeath.
Advancements in neonatal care have made a huge difference in managing high-risk pregnancies, says Dr. Mark Schemmel, a Spokane obstetrician and gynecologist. High-risk pregnancies occur on a spectrum. There are lots of ladies who have significant maternal illnesses who become pregnant and deliver healthy babies.
The numbers of high-risk pregnancies are expected to continue to go up for several reasons, including that more women are having children later in life, fertility drugs are resulting in multiple births, and diabetes is on the increase, particularly among overweight women, health professionals here say.
Still, infant mortality rates have declined substantially since 1990, says the Washington state Department of Health, and fetal deaths dropped slightly between 1990 and 2002.
The most common complications in high-risk pregnancies are diabetes and hypertension. Many health-care professionals also are seeing an increase in autoimmune disorders, such as lupus and rheumatoid arthritis. Women with autoimmune disorders may be at a higher risk for a miscarriage, experts here say.
The age of the mother and the number of fetuses she is carrying are the most common factors in whether or not a woman develops high-risk complications, they say.
Pregnant women over the age of 35 typically are placed in the high-risk category because of factors that come into play when they become pregnant and the statistical likelihood of problems, such as birth defects.
There is concern because the number of premature babies born annually has increased, says Schemmel.
We havent been able to reduce the pre-term birth rate, he says. Obstetrics is trying to figure out what causes it.
Most pregnancies last between 37 and 42 weeks, and babies born before 36 weeks of gestation are considered premature. Premature babies can have a myriad of problems, including an underdeveloped heart and lungs.
No question, the trend of delaying pregnancies (until women are older) and multiple gestations has lead to an increase in pre-term deliveries, Schemmel says.
In 2002, the most recent period for which data are available, the majority of pregnant mothers in Washington state were under 30, says the state Department of Health, although, the anecdotal evidence suggests that more women over 35 here are becoming pregnant than ever before.
Were seeing an increase of the age in pregnant women, says Brenda Covert, coordinator of Sacred Heart Womens Health Center, in Spokane. So many women are having their first child in their 40s. It does increase the risk for mom and baby.
Older women often use fertility drugs or in vitro fertilization to become pregnant, resulting in a higher number of twins and triplets.
Multiple gestations put the mother and the unborn babies at risk for health problems, says Carol Torpey, a nurse manager for labor and delivery and the manager of the center for perinatal medicine at Deaconess.
Because of multiple babies, there is more blood flow and weight gain, which puts more stress on the bodys systems, she says. The more babies there are, the greater the stress there is.
Yet, its not just older women who face serious complications. Twelve-to-15-year-old mothers-to-be often fall into the high-risk category because their bodies havent fully developed and they are susceptible to various disorders, such as preeclampsia.
That disorder, symptomized by high blood pressure and reduced kidney function, can lead to premature delivery. The cause of preeclampsia isnt known, but it can occur in older women.
In some cases, a mothers blood pressure will cause the placenta, or fluid sack that holds the fetus, to tear away from the uterus in whats called a placental abruption, which is characterized by bleeding. Typically, women with this condition are hospitalized and put on bed rest to minimize further tearing.
When its possible, labor is induced in some cases.
An important factor in high-risk pregnancies is the overall health of the mother, health-care professionals say. Weight, poor diet, and lack of exercise seem to be common denominators when women have high-blood pressure or diabetes. Deaconess and Sacred Heart Medical Center say they are treating more younger patients with diabetes than ever before.
It was never thought of as a young persons problem, but we are seeing it at earlier and earlier ages, Sacred Hearts Covert says. We try and screen before a pregnancy now. Were also trying to educate women about the risks.
Medications and hospital systems to deal with many problems found by high-risk mothers and infants have improved in recent years, health-care professionals here say.
Were making progressive steps as time goes by, Covert says. It used to be that when mom got really sick, doctors would deliver right then. But now were trying to keep her pregnant as long as possible and to keep the symptoms at bay.
For example, some pregnant women who go into pre-term labor now are placed in a warm bath, which relaxes them and increases production of amniotic fluid, which is critical for the baby to survive.
Improvements in medications, including steroids given to the mother, also have helped fetal development. Premature babies shortly after theyre delivered often are given a medicine that lubricates the lungs and helps with lung development.
Sacred Heart and Deaconess started offering round-the-clock obstetrics coverage last March to improve their handling of child-birth emergencies often associated with high-risk pregnancies. Holy Family Hospital, on Spokanes North Side, has had obstetricians on hand 24 hours a day for almost 20 years. Valley Hospital & Medical Center has such specialists on hand some nights and weekends.
Hospitals also are designing birthing centers and care units that have reduced lighting, sound, and stimulation to protect newborns from problems, such as hemorrhaging in the brain, which is believed to be caused by excessive handling.
Were able to diagnose mom and baby and give them better care if the baby is born early than we used to be able to do, Covert says.
Sacred Heart recently spent millions on upgrading its maternity unit, called The Birth Place. The unit has 15 labor-delivery rooms, 21 post-partum patient rooms, two Cesarean-section surgery suites, and a 12-bed ante-partum unit for high-risk pregnancies.
The hospitals neonatal intensive care unit has 48 semi-private rooms, allowing families more privacy than the old 16-bed ward.
Deaconess says it employs the only perinatologist, a doctor who specializes in high-risk pregnancies, in the Spokane-Coeur dAlene area. About a year ago, the hospital also bought new ultrasound equipment, which provides a three-dimensional image of the baby.
Were able to identify problems and hook up mothers with specialists before the baby is born so they can be better prepared and know exactly what the plan is after the baby is born, says Torpey. Parents arent shocked (when the baby is born) if there is a limb missing, or another abnormality, because they already know, she says. They fall in love with the baby instead of being shocked by the problems they encounter.
Pregnancy complications may be an indicator of long-term health problems, say health-care professionals here. Many of these conditions, such as diabetes and high blood pressure, usually go away shortly after a baby is delivered, but its believed that they often will resurface later in life.
Diabetes in pregnancy may well be an early expression of adult onset diabetes brought out by the pregnancy, says Schemmel. Its something thats more and more prevalent.
Its not known why complications appear during pregnancy and then disappear after a baby is born. One theory about these conditions is that the stress of pregnancy brings out previously undetected problems.
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