Understanding High-Risk Pregnancy: Specialist Care & Management
A high-risk pregnancy requires specialised care and attention to ensure the health and wellbeing of both mother and baby. Whilst the term may sound alarming, being classified as high-risk simply means that you and your baby may need additional monitoring and individualised plan to achieve the best possible outcomes. Understanding what to expect during your pregnancy journey can help you feel more confident and prepared.
What Defines a High-Risk Pregnancy?
A pregnancy is considered high-risk when there are conditions or factors that raise the chances of complications which could affect the mother, the developing fetus, or both. These factors can be present before pregnancy begins, can develop during pregnancy, or may relate to issues with the current pregnancy itself.
It is important to understand that being designated as high-risk does not necessarily mean that you will experience problems. Rather, it indicates that you may benefit from additional monitoring, specialised care, and potentially interventions to optimise your pregnancy outcomes.
Common Risk Factors
Several factors can contribute to a pregnancy being classified as high-risk:
- Maternal age: Women under 17 or over 35 years of age may face increased risks.
- Pre-existing health conditions: Conditions such as diabetes, hypertension, heart disease, kidney disease, autoimmune disorders, HIV, or obesity.
- Pregnancy-related conditions: Gestational diabetes, pre-eclampsia, or placenta praevia.
- Multiple pregnancies: Carrying twins, triplets, or more.
- Previous pregnancy complications: Prior caesarean delivery, preterm birth, or pregnancy loss.
- Fetal concerns: Growth restrictions, congenital abnormalities, or other health issues identified through screening.
Important: Many women with these risk factors go on to have perfectly healthy pregnancies and babies. The high-risk designation is primarily a tool to ensure you receive appropriate care.
Specialised Care for High-Risk Pregnancies
The management of high-risk pregnancies often involves a multidisciplinary approach, with several healthcare providers working together to provide comprehensive care:
- Maternal-Fetal Medicine Specialists: Obstetricians with additional training specifically focused on high-risk pregnancies.
- Specialised Obstetricians: Like myself, who have experience managing complex pregnancy cases.
- Other Specialists: Depending on your specific risk factors, your care team might include anaesthetists, cardiologists, endocrinologists, nephrologists, or other specialists.
Your care plan will be tailored to your specific needs and might include:
- More frequent antenatal visits, starting from your first antenatal appointment
- Additional or more specialised ultrasound scans, apart from your 12-week and 20-week scan
- Enhanced fetal monitoring
- Specific screening or blood tests
- Medications or treatments for underlying conditions
- Lifestyle modifications or activity restrictions when necessary
Enhanced Monitoring Techniques
High-risk pregnancies benefit from advanced monitoring techniques that help us track both maternal and fetal wellbeing:
- Detailed Ultrasounds: Including fetal wellbeing and growth or Doppler studies to assess blood flow.
- Biophysical Profiles: Combining ultrasound observations with NST results.
- Amniocentesis: When indicated, to check for chromosomal or genetic conditions. Learn more in our guide to understanding amniocentesis.
- Chorionic Villus Sampling (CVS): An alternative to amniocentesis that can be performed earlier in pregnancy. See our detailed explanation of chorionic villus sampling.
Managing Specific High-Risk Conditions
Gestational Diabetes
This condition affects around 1 in 20-25 pregnancies (4-5%) and develops during pregnancy, affecting how your cells use glucose. Management typically includes:
- Blood sugar monitoring
- Dietary modifications - our gestational diabetes nutrition guide provides comprehensive dietary advice
- Regular exercise when appropriate
- Medication (insulin or oral medications) if needed
Pre-eclampsia
Affecting 1 - 5% of pregnancies, pre-eclampsia is characterised by high blood pressure and signs of early damage to other organ systems. Severe pre-eclampsia occurs in about 1 in 200 pregnancies, whilst eclampsia (seizures) is rare, affecting only 1 in 4,000 UK pregnancies. Management includes:
- Regular blood pressure monitoring
- Urine tests to check for protein
- Blood tests to assess organ (kidney and liver) function
- Medications to control blood pressure
- In severe cases, early delivery may be necessary
Cervical Insufficiency
Some women may require a cervical cerclage to help prevent preterm birth. This procedure involves placing a supportive stitch in the cervix and can significantly improve birth rates for women with cervical insufficiency.
As a specialist in both transabdominal and transvaginal cerclage procedures, I have extensive experience helping women with cervical insufficiency achieve successful pregnancies. If you have concerns about cervical insufficiency or have experienced previous preterm birth, I would be happy to discuss whether cerclage might be appropriate for you. Please contact me to arrange a consultation.
Placental Complications
Placental issues require careful monitoring and often necessitate specialised delivery planning:
Placenta Praevia
When the placenta partially or completely covers the cervix, it can cause painless bleeding and requires caesarean delivery. Management includes:
- Avoiding vaginal (digital) examinations
- Monitoring for bleeding episodes
- Avoiding sexual intercourse
- Planned caesarean delivery, typically at 36-37 weeks
- Blood products on standby for delivery
Note: Women with both placenta praevia and previous caesarean section have increased risk of placenta accreta (where the placenta grows too deeply into the uterine wall). This requires specialist planning and will be discussed with you if relevant to your situation.
Placental Abruption
This involves the placenta separating from the uterine wall before birth and is a medical emergency. Risk factors include hypertension, previous abruption, and trauma. Warning signs include:
- Sudden severe abdominal pain
- Vaginal bleeding (though not always present)
- Uterine tenderness and rigidity
- Changes in fetal movement patterns
Preterm Labour Risk
Preventing preterm birth is a key focus in high-risk pregnancy care. Management strategies include:
- Cervical length monitoring: Transvaginal ultrasound to assess cervical shortening
- Progesterone supplementation: For women with history of preterm birth or short cervix
- Cervical cerclage: When appropriate for cervical insufficiency
- Activity modification: Though prolonged bed rest is no longer routinely recommended
Warning signs of preterm labour include:
- Regular contractions before 37 weeks
- Pelvic pressure or low backache
- Change in vaginal discharge
- Fluid leakage (possible membrane rupture)
If you experience any of these symptoms, contact your healthcare provider immediately.
Fetal Growth Restriction (IUGR)
When a baby is not growing as expected, careful monitoring is essential:
- Serial growth scans every 2-4 weeks
- Doppler studies to assess placental blood flow
- Regular fetal movement monitoring - learn how to do kick counts
- Consideration of early delivery if growth falters significantly
- Nutritional optimisation where appropriate
Blood Clotting Disorders
Thrombophilias and history of blood clots require specialised management during pregnancy:
- Low molecular weight heparin: Daily injections throughout pregnancy and postpartum
- Compression stockings: To prevent deep vein thrombosis
- Awareness of warning signs: Leg pain, swelling, chest pain, or breathlessness
- Specialist haematology input: For complex clotting disorders
Conditions like Factor V Leiden, protein C or S deficiency, and antiphospholipid syndrome all require individualised treatment plans.
Thyroid Conditions
Both hypothyroidism and hyperthyroidism can significantly impact pregnancy:
Hypothyroidism
- Regular thyroid function monitoring (initially every 4-6 weeks)
- Levothyroxine dose adjustments as pregnancy progresses
- Aiming for TSH in lower half of normal range
- Monitoring for symptoms of under-treatment (fatigue, weight gain, constipation)
Hyperthyroidism
- Careful medication management (propylthiouracil or carbimazole)
- Regular monitoring of thyroid function and fetal growth
- Assessment for fetal thyroid dysfunction
- Coordination with endocrinology specialists
Rh Incompatibility
If you are Rh-negative and carrying an Rh-positive baby, preventive measures are essential:
- Anti-D immunoglobulin at 28 weeks and after delivery
- Additional Anti-D after any bleeding episodes or invasive procedures
- Antibody screening throughout pregnancy
- Fetal monitoring if antibodies develop
Advanced Maternal Age Considerations
Pregnancy after age 35 carries specific considerations due to:
- Chromosomal abnormalities: Increased risk of Down's syndrome and other conditions - screening options include CVS and amniocentesis
- Pregnancy complications: Higher rates of gestational diabetes, pre-eclampsia, and placental issues
- Pre-existing conditions: More likely to have hypertension, diabetes, or fibroids
- Fertility treatments: Higher rates of multiple pregnancy
- Labour complications: Increased likelihood of intervention
However, with appropriate monitoring and care, the vast majority of women over 35 have successful pregnancies.
Previous Pregnancy Loss
A history of miscarriage, stillbirth, or recurrent pregnancy loss requires sensitive, individualised care:
- Early reassurance scans: To confirm viability and provide peace of mind
- Progesterone support: When indicated for recurrent miscarriage
- Investigation of underlying causes: Thrombophilia screening, anatomical assessment, genetic counselling
- Enhanced monitoring: More frequent appointments and growth assessments
- Emotional support: Recognition of anxiety and grief from previous losses
If you have experienced previous loss, please discuss this at your first antenatal appointment so appropriate support can be arranged.
Multiple Pregnancies
Carrying twins or more requires additional monitoring due to increased risks of preterm labour, growth discrepancies, and other complications:
- More frequent ultrasounds to track growth
- Enhanced monitoring for preterm labour signs, including understanding signs of labour
- Nutritional guidance for optimal weight gain - see our essential antenatal nutrition guide
- Specialised delivery planning
Remember: Each high-risk pregnancy is unique, and your care plan will be individualised to address your specific situation and needs.
Preparing Mentally and Emotionally
Beyond the physical aspects, high-risk pregnancies can present emotional challenges:
- Increased anxiety about potential complications
- Stress from additional medical appointments and monitoring
- Uncertainty about pregnancy outcomes
- Possible activity restrictions that may affect daily life
Coping strategies that can help include:
- Building a strong support network of family and friends
- Joining support groups specifically for high-risk pregnancies
- Practicing stress reduction techniques such as mindfulness and gentle yoga (when medically approved)
- Open communication with your healthcare providers about concerns
- Professional counselling if anxiety or depression becomes overwhelming
Birth Planning for High-Risk Pregnancies
Planning for delivery is particularly important in high-risk cases. Our essential birth preparation guide can help you understand your options:
- Discussions about optimal timing of delivery
- Consideration of delivery method (vaginal vs. caesarean) - learn more about what to expect with a caesarean section
- Choosing a hospital with appropriate facilities for both maternal and neonatal care
- Understanding potential interventions that might be needed
- Preparing for possible NICU admission if indicated
- Ensuring your hospital bag is packed with all essentials
While birth plans are always subject to change based on medical necessity, having a clear understanding of possibilities and preferences can help you feel more prepared and empowered. Consider involving your birth partner in these discussions.
Activity Restrictions and Bed Rest
Whilst complete bed rest is no longer routinely recommended due to risks of blood clots and muscle weakness, some activity modification may be necessary:
When Activity Restriction May Be Advised
- Placenta praevia with bleeding
- Incompetent cervix or after cerclage placement
- Severe pre-eclampsia
- Multiple pregnancy with complications
- Threatened preterm labour
Types of Restriction
- Pelvic rest: Avoiding sexual intercourse and vaginal examinations
- Work modifications: Reducing hours or changing duties
- Limited activity: Avoiding heavy lifting, prolonged standing, or strenuous exercise
- Modified bed rest: Spending most of the day resting but with bathroom privileges and limited movement
Coping with Restrictions
Activity restrictions can be mentally and physically challenging:
- Gentle leg exercises to maintain circulation
- Maintaining social connections through phone and video calls
- Accepting help with household tasks
- Planning activities you can do whilst resting (reading, podcasts, gentle hobbies)
- Discussing concerns with your healthcare team
Medication Safety in High-Risk Pregnancy
Managing chronic conditions often requires ongoing medication, but not all drugs are safe in pregnancy:
Generally Safe Medications
- Insulin for diabetes
- Levothyroxine for hypothyroidism
- Low-dose aspirin (when indicated)
- Methyldopa or labetalol for hypertension
- Low molecular weight heparin for clotting disorders
Medications Requiring Adjustment or Alternatives
- ACE inhibitors/ARBs: Must be stopped before pregnancy; alternatives available
- Statins: Generally discontinued during pregnancy
- Some anti-seizure medications: May need adjustment with folic acid supplementation
- Certain antidepressants: Risk-benefit discussion needed; some are safer than others
Critical: Never stop prescribed medications without discussing with your healthcare provider. Some conditions pose greater risks if untreated than the medication itself. Always have a medication review before pregnancy or as soon as pregnancy is confirmed.
When to Seek Immediate Medical Attention
In high-risk pregnancy, certain symptoms require urgent evaluation. You or your partner should contact your healthcare provider immediately or attend A&E if you experience:
Severe Symptoms (Call 999)
- Heavy bleeding: Soaking through a pad per hour
- Severe abdominal pain: Particularly if sudden onset or one-sided
- Seizures or fits
- Severe, persistent headache with visual disturbances (seeing spots or flashing lights)
- Chest pain or difficulty breathing
- Sudden severe swelling of face, hands, or feet
- Collapse or loss of consciousness
Urgent Symptoms (Contact Healthcare Provider Immediately)
- Reduced fetal movements: If your baby's movement pattern changes significantly - see our guide on monitoring baby's movement
- Leaking fluid: Possible rupture of membranes
- Regular contractions before 37 weeks
- Severe, persistent vomiting preventing fluid intake
- Signs of blood clot: Painful, swollen, red leg; sudden breathlessness
- High temperature above 38°C that is not controlled with paracetamol
- Burning or pain when urinating (possible infection)
Trust your instincts: In high-risk pregnancy, it is always better to be checked and reassured than to delay seeking help. Your healthcare team would much rather see you for a false alarm than miss something important.
Frequently Asked Questions
A pregnancy is considered high-risk when conditions or factors raise the chances of complications affecting the mother, fetus, or both. This includes maternal age under 17 or over 35, pre-existing health conditions like diabetes or hypertension, pregnancy-related conditions such as gestational diabetes or pre-eclampsia, multiple pregnancies, previous pregnancy complications or trauma, or identified fetal concerns. Being high-risk means you may need additional monitoring and specialised care.
High-risk pregnancy care involves maternal-fetal medicine specialists, experienced obstetricians, and other healthcare professionals as needed. Care includes more frequent antenatal visits, additional specialised ultrasounds, enhanced fetal monitoring, specific screening tests, medications for underlying conditions, and lifestyle modifications when necessary. The care plan is tailored to your individual needs.
Gestational diabetes management includes blood sugar monitoring, dietary modifications, regular exercise when appropriate, and medication (insulin or oral medications) if needed. Your healthcare team will provide guidance on nutrition, monitoring schedules, and any necessary treatments. For comprehensive dietary guidance, see our gestational diabetes nutrition guide.
Enhanced monitoring includes detailed ultrasounds (fetal growth and wellbeing, Doppler studies), biophysical profiles combining ultrasound with NST results, and when indicated, amniocentesis or chorionic villus sampling for chromosomal or genetic testing.
In addition, fetal heart rate monitoring becomes increasingly important from 28 weeks onwards.
Many women with high-risk pregnancies can still have vaginal births. The delivery method depends on your specific condition, how well it is managed, and your baby's wellbeing. Your consultant will discuss the optimal timing and method of delivery, considering all factors to ensure the safest outcome for you and your baby.
Appointment frequency varies based on your specific risk factors and how your pregnancy progresses. Generally, high-risk pregnancies require more frequent visits than standard pregnancies - this could mean weekly or even twice-weekly appointments in some cases, especially in the third trimester. Your consultant will create a monitoring schedule tailored to your needs.
Pre-eclampsia is characterised by high blood pressure and signs of damage to other organ systems during pregnancy. Management includes regular blood pressure monitoring, urine tests for protein, blood tests to assess organ function, medications to control blood pressure, and in severe cases, early delivery may be necessary. Close monitoring is essential.
Cervical cerclage may be recommended if you have cervical insufficiency or a history of preterm birth due to cervical issues. This procedure involves placing a stitch in the cervix to help support it during pregnancy. Your consultant will assess your history and current pregnancy to determine if cerclage is appropriate. Learn more in our complete guide to cervical cerclage.
Pregnancy after 35 carries increased risk of chromosomal abnormalities like Down's syndrome, higher rates of gestational diabetes and pre-eclampsia, placental complications, and increased likelihood of requiring intervention during labour. However, with appropriate monitoring and specialist care, the vast majority of women over 35 have healthy pregnancies and babies. Early screening and regular monitoring help identify and manage any issues promptly.
Complete bed rest is rarely recommended now due to risks of blood clots and muscle weakness. However, activity modification may be advised for specific conditions like placenta praevia, incompetent cervix, or threatened preterm labour. This might include pelvic rest, work modifications, or limited activity rather than complete bed rest. Any restrictions will be individualised to your situation and regularly reviewed.
Some medications are safe during pregnancy whilst others need to be adjusted or changed to safer alternatives. Never stop prescribed medications without medical advice, as untreated conditions can pose greater risks than the medication itself. Common safe medications include insulin, levothyroxine, and certain blood pressure medications. ACE inhibitors, statins, and some other drugs require alternatives. Always have a medication review before pregnancy or immediately upon confirmation.
Placenta accreta occurs when the placenta attaches too deeply into the uterine wall, making separation after delivery dangerous. It is more common with previous caesarean sections and placenta praevia. Management requires specialist multidisciplinary planning, delivery at a tertiary centre with blood bank facilities, and may involve hysterectomy to control bleeding. Careful antenatal counselling about risks and options is essential.
Previous miscarriage, stillbirth, or recurrent pregnancy loss means you will receive extra support including early reassurance scans, possible progesterone supplementation, investigation of underlying causes (thrombophilia, anatomical issues), and enhanced monitoring throughout pregnancy. Emotional support is equally important given the anxiety and grief from previous losses. Discuss your history at your first appointment so appropriate care can be arranged.
Mr Myriknas practices at The Kensington Wing within Chelsea and Westminster Hospital, located at 369 Fulham Road, London SW10 9NH. This specialist private maternity unit serves patients across Chelsea, Kensington, Westminster, Fulham, and Central London, offering state-of-the-art facilities for high-risk pregnancy care and delivery.
Final Thoughts
Every high-risk pregnancy journey is unique, and the level of care required can vary dramatically. What matters most is that you feel supported, informed, and confident in your care team throughout this important time.
The NHS provides excellent care throughout pregnancy, but I understand that high-risk situations can feel particularly anxious. In my private practice, I am able to offer more frequent monitoring, earlier intervention when needed, and the continuity of seeing the same consultant who knows your history intimately. Whether it is reassurance between appointments, additional scans for peace of mind, or simply having direct access when concerns arise - sometimes that extra level of support can make all the difference during a high-risk pregnancy.
If you are facing a high-risk pregnancy and wondering whether private care might be right for you, I would be delighted to discuss how my team and I can support you. To learn more about our private maternity services or to schedule a consultation, please get in touch.
