 Hello, my name is Manasa and today we are going to be discussing about high-risk pregnancies. And we have with us today Dr. Jyotsana Madan, senior consultant in obstetrics, gynecology in Manipal Hospital's Jainagar. She has over 30 years of experience and her interests include high-risk pregnancies and its challenges. Welcome doctor, thank you so much for being here. I hope you'll answer our queries and questions about high-risk pregnancies. So doctor, I'd like to start with knowing what exactly is high-risk pregnancies. See, coming to the point, all pregnancies fall under high-risk category. We usually never call a patient as low-risk, but we have a terminology called high-risk. The reason is the lady who does not have any other factors other than she being pregnant, she doesn't have any other complications, she though falls under low-risk, any time during pregnancy she may get converted to high-risk, like she can develop other complications. But to begin with she is a low-risk but still we never label. But a patient when she is coming to me for the first time to the hospital in the beginning of her pregnancy, I always have that habit of writing HRP, that is high-risk pregnancy, because in the beginning itself she is fallen under some of the risk categories. Okay, okay. So doctor roughly what percentage of your patients come under this condition? Okay, as the years are going by I think we have been seeing a lot of increase in the incidence of high-risk pregnancy. See I can say 3 decades back it was just about 1-2% which became about 10% a 2 decades back and now I can say 30-35% of our patients have one or the other risk factor. Okay, okay. So doctor which patients do you categorize under high-risk pregnancies? Yes, recurrent pregnancy loss which was very less earlier now we see lot of women having abortions 1, 2, 3 previous abortions. So when she is got more than 2 abortions we call her as a patient with recurrent abortions and she needs to be tackled in a different way compared to another patient who is just conceived and pregnancy goes smoothly to the term. Then diabetes in pregnancy which was very very rare probably 1% or even less 30 years ago in Indian population has become now very common as many as 10 to 15% of our pregnant women we see complicated with the diabetes. So obviously that requires special care hypertension during pregnancy, anemia during pregnancy, bleeding disorders like bleeding can be because of the placenta lying low or whatever may be the reason they come under high-risk and one of the common reason for high-risk is previous caesarean scar. Earlier the primary c-section rate was low so the recurrent caesarean section rate was also low but now because of all these risk factors there's been a tremendous increase in the incidence of caesarean section. So this patient who is already has a scar when she comes to me next time I will obviously labor her as high-risk pregnancy and put the cause for high-risk factor being previous c-section. And to emulate one more thing in in vitro fertilization lot of infertility lot of late marriages late conceptions leading to assisted reproductive techniques treatment with in vitro fertilization. So she's a woman at 38 and conceived after 15 years of marriage I would not want to treat her like I'm going to treat a woman who is 28 year old married just six months back and she's had a spontaneous conception right. So IVF conception also comes under high-risk category. Okay so doctor why do you think there has been a surge in incidence of caesarean rate a lot of people have been talking about how there's an increase in caesarean section so why do you think that is doctor? Recurrent pregnancy loss which was very less earlier now we see lot of women having abortions one two three previous abortions so when she's got more than two abortions we call her as a patient with recurrent abortions and she needs to be tackled in a different way compared to another patient who is just conceived and pregnancy goes smoothly to the term. Then diabetes and pregnancy which was very very rare probably 1% or even less 30 years ago in Indian population has become now very common as many as 10 to 15% of our pregnant women we see complicated with the diabetes so obviously that requires special care hypertension during pregnancy anemia during pregnancy bleeding disorders like bleeding can be because of the placenta lying low or whatever may be the reason they come under high-risk and one of the common reason for high-risk is previous caesarean scar. Earlier the primary c-section rate was low so the recurrent recurrent caesarean section rate was also low but now because of all these risk factors there's been a tremendous increase in the incidence of caesarean section so this patient who is already has a scar when she comes to me next time I will obviously labor her as high-risk pregnancy and put the cause for high-risk factor being previous c-section and to emulate one more thing in in vitro fertilization lot of infertility lot of late marriages late consumptions leading to assisted reproductive techniques treatment with in vitro fertilization so she's a woman at 38 and conceived after 15 years of marriage I would not want to treat her like I'm going to treat a woman who is 28 year old married just six months back and she's had a spontaneous conception right so IVF conception also comes under high-risk category so doctor why do you think there is an increase in diabetic pregnant women these days okay see first of all that our ancestors being diabetic the incidence was very less so their next generation of the coming generation and all that developing genetic predisposition of diabetes was less 3d 3 generations ago now for the last 20 years diabetes has become common in India in fact in another one decade probably it'll be number one India will be number one in diabetic number of diabetic patients so obviously if she is a girl born to a diabetic parents she has more genetic predisposition another reason could be obesity eat lifestyle modifications eating habits lot of them get involved into junk eating junk food and BMI which should normally be 18 to 25 many of our patients we see morbidly obese with the BMI of 30 and so so that itself becomes a high-risk factor for them to develop diabetes during pregnancy so doctor are all obstetricians are all hospitals equipped with dealing with such high-risk pregnancies yeah I think so most of us deal most of the hospitals have facilities except for the small nursing homes where they do not have an ICU care or to arrange if there is any bleeding or to arrange anything in cases of emergency ICU they do not have otherwise most of the hospitals do have at least at present doctor have you come across a lot of patients that require assisted reproductive treatment that is again is on the increase same reasons apply to that also lifestyle modification nobody gets involved into physical activity everybody is sitting at the desk and working for hours together and they're late sleeping hours late waking apart everything is adding on to their obesity so when they are obese they have a common condition called as polycystic ovarian disease which is which we see at least in 40 to 50 percent of our young girls in the reproductive age group so this is all increasing in many of them can respond to simple treatment which we give but when they fail to respond to simple treatment they need to go in for either IVF IUI that kind of assisted reproductive techniques basically it's a lifestyle and the obesity which has led to so many other factors either before she concedes or during conception and even postnatally so doctor what exactly is the high dependency unit and how is it used high dependency unit is a place where it is equipped well to handle a patient suppose there can be something called as amniotic fluid embolism she just like that collapses or there is a case of bleeding she can go into shock anytime there she has to be revived so having all the facilities available in a waiting area when patient is in labor she is in waiting period and she has everything available and the ICU is very close by just in case we need to shift her or operation theater is just close by in the same floor we need to shift her that is what is called as high dependence unit and with facilities available being available for monitoring both the mother and the fetus so doctor what exactly is high dependency unit and how is it used like I mentioned earlier obesity is the leading cause for PCOS and PCOS patients invariably will have many of the other autoimmune conditions like hypothyroidism and diabetes so all of them put together she she obviously when she concedes either by chance naturally or with a simple ovulation induction or with IVF she is going to fall under high risk category so obviously when she's been trying for pregnancy for many years and not being able to conceive due to her PCOS should have probably been a elderly gravita also so age about 35 years is again another risk factor okay so doctor in case of an emergency is the hospital equipped with a blood bank see there there are certain criteria for the blood bank to be available in all the hospitals it has to fulfill the availability of the blood bank should be fulfilled the require prerequisites are there so the hospital has to fulfill all those prerequisites only then blood bank can be run however in our hospital multi-manipal though it doesn't have a blood bank of its own it has a parent hospital main-manipal from where they organize blood but just in case due to distance we are dire in need of blood it's in minutes to like you know within half an hour we need to arrange blood we can always get it from nearby blood banks so not all the hospitals are equipped with equipped with blood bank but definitely they have tie up with some of the blood banks and it can be brought immediately okay so doctor in case of emergencies do you have a blood bank or are there any other precautions taken for that many times we are consultants may not be available all the time to deliver a patient so from the time of admission to delivery so we have our junior consultants who are registrars and they are all well equipped with high-risk pregnancy and what has to be done because high-risk pregnancy has to be monitored more closely compared to a otherwise a patient who does not have high-risk factors I don't call it as low-risk okay so as the junior doctors are aware and our nurses and the labor rooms to other staff they are all definitely aware of this that's the reason many times we insist that they should not shift labor room staff or hospital I mean operation theater staff to other places on rotation so usually they continue working in the same area so that they are aware they would have gained knowledge by that so doctor are all your staff members and nurses equipped with dealing with such high risk pregnancies yes and I think your question has been answered about the caesarean section rate being high that's because primary C section rate due to all these risk factors being high this lady at the age of 38 if she's giving birth to a first child when she comes back with the previous caesarean scar at the age of 40 obviously she's going to be an under high-risk category so doctor in covert times what are all the precautions you take in dealing with such high-risk pregnancies see this is a pandemic which which has affected whole world and obviously it is affected many of our pregnant women and we need to be we being medical and medical personnel or those who are working at the hospital they are more at risk of contacting the disease so we take at most precautions wearing PPE kids during delivery or outpatient wearing double mask with shield and things like that changing the gown gloves every time we see a patient and definitely this patient our obstetric patients when they can see when they are already pregnant if they have contacted the disease it can easily be treated and later on she can be delivered but sometimes we are doing COVID-19 tests for all of them at term just before delivery suppose if they turn out to be positive then in such cases we need to take even more extra precautions than a COVID negative mother during delivery all the hospital staff should be informed she should be in isolation room thank you so much doctor for throwing some light on our queries and doubts about high-risk pregnancies Manasa you asked me some few questions about high-risk pregnancy even one day if it is given it's not just enough to clarify all the doubts about high risk pregnancy because 30% of our population is come under this category of high-risk pregnancy and each high-risk pregnant patient is different from the other one so any doubts anybody has regarding this they can contact the hospital Manipal Hospital Jainagar at the given number thank you if you have any doubts or questions regarding high-risk pregnancies please contact the number given below thank you