Coping with High-Risk Pregnancy

"We're going to refer you to a prenatal specialist, because it looks from the ultrasound that your baby has a two-vessel umbilical cord instead of the normal three-vessel cord." The nurse told us this in late January; we were expecting a little girl to be born early in May.

Dr. Tracie Traver, MD, reassured us in her low-key way. The perinatal specialist had more resources and a counselor to work with us, and we conducted research on our own. We soon learned that a two-vessel cord could cause problems. Our daughter had a much greater chance of having other chromosomal abnormalities, including Down syndrome.

A high-definition ultrasound verified the two-vessel cord and also showed that the kidneys and heart of our unborn daughter, Hannah, were developing normally. But the two-vessel cord alone admitted us to a select, nervous fraternity: high-risk pregnancy.

What Is High-Risk Pregnancy?

Defining high-risk pregnancy isn't easy. The Merck Manual says it's "a pregnancy in which the risk of illness or death before or after delivery is greater than usual for the mother or baby."

That's a pretty broad definition. Dr. Gerard M. DiLeo, MD, a long-time obstetrician, explains that every doctor has his or her list that determines high-risk pregnancy.

Specific conditions are easier to pin down. According to the March of Dimes Medical Reference, for example, about 1 percent of pregnancies with a single fetus and about 5 percent with multiple fetuses have umbilical cords with only one artery and one vein instead of the normal two arteries and one vein. About 25 percent of such babies have birth defects, according to the March of Dimes.

At Fort Sanders Perinatal Center in Knoxville, Tennessee, where certified nurse midwife Donna Morgan works, the literature says expectant women with high-risk pregnancies may experience many of the following conditions:

• diabetes
• risk of preterm labor.
• hypertension
• risk of having a child with a birth defect
• cardiovascular disease
• family history of genetic disease
• multiple pregnancies
• complications in previous pregnancies

Many of those conditions have underlying factors. The Merck Manual scoring system comprises 71 items with weighted scores ranging from one to 10 for each. Thirty-five of them have a score of five. Twenty-eight have a score of 10 all by themselves. A total score of just 10 gets you into the high-risk category.

Before Diagnosis

Whether you have high-risk factors or not, consider what you will do if a problem occurs during pregnancy. Ask yourselves, "In such a case, do we continue the pregnancy or not? Can we handle a special-needs child?"

We decided we would have our baby, even if we knew of a problem, and making this decision led us to make several more. We decided not to have an amniocentesis, for instance. The procedure itself carries some risk of miscarriage, and for us it would only have served to allay some concerns a few weeks earlier.

That doesn't mean you shouldn't have such tests. It just means that basic decisions drive other decisions.