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Prenatal risk placement

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Everyone welcome back to parently Dr. Mark Boyd here and today we're going to try to identify whether you are a low risk patient for pregnancy or a high risk patient for pregnancy. Now, it's important to understand why we're stratifying you into these different groups. Most important reason for you as a patient is if you fall into one of these high risk groups, you need to plan on seeing the doctor more frequently, potentially ended up on bedrest potentially ending up in the hospital. And lastly, the most important issue is am I going to have to be delivered early either by induction or by Syrian section. These are all very important financially. These are all very important as far as your job is concerned.

This is all very important as it relates to other family members, meaning specifically your husband and other children. Now, low rent risk pregnancy versus high risk pregnancy. Most important thing to understand is most women that are pregnant are low risk. It's important to understand, even if you're a low risk patient, that you can become a high risk patient during your pregnancy. And it's important to understand what that means. We're going to specifically talk about what defines a low risk patient versus a high risk pregnant patient at the beginning of the pregnancy.

This is not a complete list, but these are identifying factors that your healthcare provider will look at when he or she is talking to you. The most important issue in today's medical world is obesity. Obesity is now the number one risk factor for all healthcare problems in the United States. Obesity is defined as a BMI of greater than 30. Now, do you fall into that category? Well, you get on a scale weigh yourself.

Measure yourself as height goes as far as your height goes, and you can establish whether your BMI is greater than 30. You just can't Online, plug in your height, plug in your weight and you will be assigned a BMI. Body Mass Index of greater than 30 is defined as obese. BMI greater than 35 is defined as morbidly obese. BMI greater than 35 increases your risk for hypertension during your pregnancy and increases your risk for diabetes during your pregnancy and increases your risk for needing a cesarean section because your baby's grown too large during the pregnancy and you're unable to deliver Badgley. So obesity is the number one risk factor again, in today's medical world for establishing whether you're low risk or high risk.

The second category is previous medical problems specifically, do you have hypertension? That means elevated blood pressure? Are you on medication for your hypertension or are you not? Do you have diabetes, or do you have pre diabetes? Going back to category number one, if you're obese, you have an increased risk for having diabetes and not necessarily knowing that, but when you're obese, you're also at increased risk for developing gestational diabetes. That means diabetes during your pregnancy.

Other issues that would fall into the medical history would be a woman that has had a previous history of cardiac issues or heart problems. A woman that's had kidney problems, a woman that has autoimmune problems, all of those are going to place you into a high risk category. The third issue that we look at as far as high risk and low risk is your age. women that are less than 16 and greater than 35 have an increased risk for preeclampsia during their pregnancy. Now preeclampsia, women have heard that term before. Maybe your mother said toxemia.

It's all the same problem. It means three things it means you have elevated blood pressure, it means you smell protein, and it means you have swelling. Those three categories make up the definition of preeclampsia. There's a mild form and a severe form but Each patient less than 16 greater than 35 has an increased risk for developing preeclampsia. The fourth issue, not always known when we start the pregnancy is a woman that has more than one baby. So a woman that has twins, or a woman that has triplets or quadruplets.

In today's world with in vitro fertilization, women oftentimes will have multiples and that means two, three or four babies or more, that woman automatically ends up in the high risk category. The last issue that we look at is your previous obstetrical history. your previous obstetrical history is very, very important for your health care provider at the onset of your pregnancy to know whether you're at high risk, and I'm gonna look at the patient both at the beginning of your pregnancy, the middle of your pregnancy at the end of your pregnancy, last pregnancy and the pregnancies before to establish whether you fall into this high risk category and I'm gonna give you several examples. If you've had a pregnancy loss In the middle of your second trimester, that means somewhere between 18 and 25 weeks and had a pregnancy loss where your baby just was delivered badly.

You may have what's called cervical incompetence. That would be a patient that would need a sir clause during your pregnancy you would and you would be automatically placed in the high risk category. The second patient would be a patient though delivered really, really early in her pregnancy. For example, She had a preterm delivery as early as 24 weeks, all the way up until 36 weeks so any woman etc. preterm delivery, whether it was vaginal delivery are certain section, you're at high risk for to have that happening again. So you would be placed in the high risk category.

The next patient would be a woman that had a stillborn, that means a baby that's died in utero. Sometime during her pregnancy after the 24th week, she would be at increased risk for having that happen again, and she would be followed in a closer manner than somebody that has not had a stroke. The last issue is a woman that's had a difficult delivery whether it was a vaginal delivery with forceps of delivery with a severe tear, a Syrian section that required a blood transfusion, a lady that had a blood loss that was significant after her delivery where she required a blood transfusion. All of those patients would be defined as a high risk patient. As far as obstetrical pregnancy this time is concerned, and she would be monitored closer, especially she especially as she got closer to the end of her pregnancy. Now, it's important to understand this is not an absolute list.

This is a general list, but it needs to be known. These facts need to be known early in your pregnancy so that your healthcare provider can establish whether you need to be seen by somebody else. And I'll give you a couple of examples. So if you're being taken care of by a family doctor, or a nurse midwife, and you have any of these high risk issues, you need to be referred to an obstetrician gynecologist and or a maternal fetal medicine specialist. That's another name for a what's called a perinatologist. So, in a high risk pregnancy you should be taken care of by a Board Certified obstetrician gynecologist in conjunction with a perinatologist.

Very important that you establish that early on. That's it for today. We'll see you next time.

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