A high-risk pregnancy carries greater risk for the mother and her fetus compared to an uncomplicated pregnancy. Reasons for a pregnancy being considered high-risk include maternal age (women under 18 or over 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s), hyperpigmentation, multiple pregnancies, severe medical conditions (such as diabetes, anemia, or chronic hypertension), urogenital disorders, specific infections, spontaneous or induced abortions, congenital fetal anomalies, previous cesarean sections, or other surgical procedures of the uterus.

A multiple pregnancy involves two or more fetuses. Twin pregnancies can occur by fertilizing one or two eggs. In recent years, there has been an increase in the rate of multiple pregnancies, mainly due to the rise in maternal age and the use of assisted reproduction techniques.

Premature birth is the birth of a baby before 37 weeks of gestation, as opposed to the usual 40 weeks. Premature birth is one of the most serious obstetric complications, with about 1 in 10 pregnancies resulting in the premature birth of a small baby.

While a baby is in the womb, it is situated within the amniotic sac, a bag formed of two membranes. The fetus grows and develops inside this sac, surrounded by amniotic fluid. When the amniotic sac breaks before the 37th week of pregnancy, it is called premature rupture of the membranes (PROM). A significant risk of PROM is that the baby is very likely to be born within a few days of the membrane rupture. Other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, cesarean birth, and postpartum infection.

A normal pregnancy can last up to 41 weeks. The term “prolonged pregnancy” describes a pregnancy that persists longer than 41 weeks from the first day of the last menstrual period with a 28-day menstrual cycle. The incidence of post-term pregnancy is about 7% of all pregnancies. The prevalence varies depending on population characteristics and local management practices.

In premature separation, the placenta detaches from the uterus before childbirth. Normally, separation occurs after delivery.

Placenta Accreta occurs when the placenta attaches too deeply to the uterine wall. This can lead to two major complications: the placenta may not detach normally after the baby’s birth, and attempts to remove it can cause heavy bleeding.

Spontaneous abortion refers to the termination of pregnancy before the 20th week. The clinical classifications are as follows:

• Threatened Miscarriage: Vaginal bleeding in early pregnancy, with or without contractions.

• Inevitable Miscarriage: Cervical dilation, pain, abdominal or lower back pain, and possibly rupture of membranes.

• Incomplete Miscarriage: Bleeding has begun, the cervix is dilated, but pregnancy tissue remains in the uterus.

• Complete Miscarriage: The fetus, membranes, and placenta are expelled completely, and the cervix closes before 20 weeks.

• Early Miscarriage: Necrosis and retention of the fetus without pain and bleeding, possibly for a long time, and lack of common early pregnancy signs such as nausea and breast tenderness.

• Septic Abortion: Serious uterine infection during or shortly before or after an abortion.

Recurrent miscarriage refers to three or more consecutive miscarriages without childbirth. These losses occur at a gestational age of less than 20 weeks and with embryos weighing less than 500 grams.

Anemia is a common complication during pregnancy. Due to physiological changes, anemia is even more prevalent in pregnant women. It is often associated with poor nutrition and inadequate medication. Anemia during pregnancy can be classified as iron-deficiency, vitamin B12 deficiency, or folate deficiency.

Hyperemesis gravidarum is an extreme form of morning sickness that causes severe nausea and vomiting during pregnancy, leading to weight loss and dehydration.

The most common classifications include Type 1 diabetes mellitus, Type 2 diabetes mellitus, and gestational diabetes.

• Type 1 Diabetes: Insulin-dependent diabetes, often requiring insulin administration. With proper management, a normal birth can occur at 40 weeks, provided there is no macrosomia.

• Type 2 Diabetes: Non-insulin-dependent diabetes, usually occurring after age 30, often associated with increased appetite and obesity. Pregnant women with Type 2 diabetes must be monitored by a diabetologist to manage risks to the fetus, such as hydration issues, respiratory distress, and other complications. Breastfeeding is encouraged as it can reduce the mother’s insulin requirements and benefit the newborn. Children of diabetic parents are at greater risk of developing diabetes in the future.

Macrosomia refers to fetuses that are larger than expected for their gestational age, with a body weight ranging from 4,000 grams to above 5,000 grams.

During pregnancy, blood pressure can drop in the first trimester, increase until the 20th week, and then return to pre-pregnancy levels near the end. Hypertensive pregnancy is a common complication that occurs after the 20th week, with blood pressure greater than or equal to 140/90 mm Hg. It can be classified as follows:

• Hypertension that first appears during pregnancy.

• Preeclampsia: A complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys.

• Eclampsia: A severe complication of preeclampsia, resulting in seizures during pregnancy.

Bed rest and childbirth play a key role in managing preeclampsia. After childbirth, there is usually a dramatic improvement in the patient’s condition.

This syndrome is characterized by hemolysis, elevated liver enzymes, and low platelet counts. It occurs in 50% of pregnant women with eclampsia but can also manifest with a moderate increase in blood pressure. Predisposing factors include advanced maternal age and having multiple pregnancies.

Chronic hypertension is defined as high blood pressure diagnosed before pregnancy or before 20 weeks’ gestation, or hypertension that persists for more than 6 weeks after delivery. It is associated with:

• Serious maternal and fetal complications, including superimposed preeclampsia.

• Fetal growth retardation.

• Premature delivery.

• Placental abruption.

Ectopic pregnancy occurs when the embryo attaches outside the uterus, often in the fallopian tube (98% of cases), abdominal cavity, or cervix. Causes vary and can include inflammation and scarring of the fallopian tubes, infection, surgery, hormonal factors, genetic abnormalities, birth defects, endometriosis, or a previous ectopic pregnancy. Diagnosis is made through ultrasound, blood tests for hCG and progesterone levels, and laparoscopy. Treatment may involve medications or surgical intervention.

This group of diseases occurs when a pregnancy does not develop properly, resulting in conditions like a molar pregnancy or choriocarcinoma. For every 700 pregnancies ending with a live baby, one may develop GTD.

Molar pregnancy (hydatidiform mole) is the most common type of GTD. It results from an imbalance in the number of chromosomes from the mother and father. There are two types:

• Complete Mole: Occurs when a single sperm fertilizes an empty egg or when two sperm fertilize an empty egg.

• Partial Mole: Occurs when two sperm fertilize a normal egg, resulting in three sets of chromosomes or more. Early signs may include irregular or heavy bleeding, excessive morning sickness, and an enlarged uterus.

It is important for all pregnant women to get tested for HIV, as treatments can reduce the chances of transmitting HIV to the baby.

This bacterial infection occurs before or during labor, affecting the membranes surrounding the fetus and the amniotic fluid. It can lead to preterm birth or serious infection in the mother and baby. Symptoms may include fever, rapid heartbeat, uterine tenderness, and discolored, foul-smelling amniotic fluid.

In some women, the cervix may open long before the baby is due, leading to delivery during the second trimester.

Cervical cerclage, or cervical stitch, is used to treat cervical weakness. It involves sewing a strong suture into and around the cervix early in pregnancy (usually between weeks 12 to 14) and removing it towards the end of pregnancy. This procedure helps to reduce the likelihood of preterm birth and minimizes risks to the baby.