High-Risk Pregnancy Assessment: When Is a Pregnancy Considered High Risk and How Does Monitoring Change?

A high-risk pregnancy is a pregnancy in which the likelihood of some health problems in you or in your baby is increased. This is not an outcome but a warning sign: it shows that your monitoring needs to be planned more closely. Your risk status is determined at the first assessment made at the start of pregnancy and is reviewed throughout pregnancy. Being called high risk does not mean that a problem will be experienced; it only makes it possible for monitoring to be shaped according to you. Which situations will be regarded as high risk, how monitoring will change and, if necessary, where you will be referred are decided by the doctor who follows you.

Does being called high risk necessarily show that problems will occur?

This label shows that the likelihood has increased; it does not foretell an outcome. No problem at all may arise in a pregnancy regarded as high risk; an unexpected situation may also appear in a pregnancy regarded as low risk. For this reason urgent symptoms are assessed with the same seriousness in every pregnancy.

Can your risk status change as pregnancy advances?

As pregnancy advances new findings may appear; existing problems may improve or worsen. Your monitoring plan is updated according to these changes.

Which situations can make a pregnancy high risk?

The headings below are examples; there may also be situations outside them. You cannot determine whether you are regarded as high risk by looking at a single factor; your doctor makes this assessment.

Do illnesses you had before pregnancy affect monitoring?

If you have chronic health problems such as high blood pressure, diabetes, heart disease, thyroid disease and blood diseases, your monitoring may change.

What is the place of your earlier pregnancies in the assessment?

If you have previously had preterm birth, recurrent pregnancy loss or pre-eclampsia, which goes with high blood pressure, this also enters the assessment.

Which findings in this pregnancy can affect the risk assessment?

Multiple pregnancy, problems related to the baby's growth, blood group incompatibility between you and your baby, and high blood pressure or high blood sugar arising during pregnancy fall into this group.

Are your age and living conditions decisive on their own?

Your age and living conditions are also part of the assessment, but they are not decisive on their own.

How is risk assessed at the first consultation?

At the first consultation your pregnancy history, your general state of health, your mental health, and your living and working conditions are assessed; if necessary you are also asked whether you need additional support. Carrying out a risk assessment at the first examination and re-determining the monitoring plan according to this assessment is also part of the monitoring practices in Turkey.

How does the risk assessment continue at later check-ups?

At later check-ups, signs of a new problem are looked for with simple measurements such as blood pressure and urine. That is, the first assessment is only a starting point.

Are more frequent check-ups needed in a high-risk pregnancy?

In a high-risk pregnancy, check-ups may be planned at more frequent intervals; additional ultrasound, additional laboratory tests or tests that monitor the baby's wellbeing may be requested. How many check-ups are needed and which tests will be requested vary from person to person. Your care is generally planned by the midwife, and the doctor also steps in when necessary.

Is it necessary to go to an advanced centre in every high-risk pregnancy?

In some situations your pregnancy may need to be followed at a centre with the necessary equipment or by a team in which several specialists work together. This need varies from person to person; you do not need to go to an advanced centre in every high-risk pregnancy.

How can you support yourself in a high-risk pregnancy?

• Do not skip the planned check-ups.
• Do not make changes to the regular medicines you take without consulting your doctor.
• Note down newly appearing symptoms and report them without delay.
• Go to the consultation with a list of questions.
• Do not hide feelings of anxiety, guilt or hopelessness; you can ask for mental health support.

What can you ask your doctor when discussing your monitoring plan?

• Ask for which factor your pregnancy is regarded as high risk.
• Find out in which respects my monitoring will differ from a standard pregnancy.
• Ask which symptoms should make me seek care without waiting for the check-up date.
• If there is a possibility of referral to another centre, discuss in which situation it would be considered.