High Risk Pregnancy

Many patients come to us because they have had problems in a previous pregnancy, or have medical problems that create increased risks in this pregnancy (or both). For example, we see many patients with multiple gestation, with pregnancy after previous infertility, with pregnancy after age 35, or with a previous complicated pregnancy. Not everyone with risk factors is automatically considered by us to be a high-risk pregnancy. Generally we reserve that term for patients who require extra medical care during this pregnancy.

Additionally, we are always aware that even a patient whose pregnancy begins seemingly normal can develop problems later on sufficient to make the pregnancy a high-risk situation.

One aspect of our practice that we are proud of is our ability to offer nearly all possible medical services to you here in our office. We perform ultrasound and doppler studies in the office. We do fetal monitoring and premature labor monitoring here in the office. We perform intravenous hydration in the office when needed. Furthermore, we can arrange for medical care at your home as well, such as a fetal non-stress test, premature labor monitoring or home intravenous therapy.

Below is a brief discussion of some of the extra services available as well as special considerations when there are problems or complications with the pregnancy.

SPECIAL BLOOD TESTS

There are hundreds of blood tests available should the situation warrant it. Thyroid panels, anemia panels, thrombophilia testing, progesterone levels, TORCH titers (viral antibodies), lupus panels, coagulation panels, and anticardiolipin antibody panels are just a few. 

PROGESTERONE THERAPY

Sometimes early in pregnancy there are problems which suggest a need for additional progesterone (for example, twins, history of previous miscarriage, or bleeding during the first trimester). We have a program of supplementation with pure, natural progesterone (either as a capsule, vaginal suppository or injection) and blood level monitoring for those situations. 

MEDICAL SERVICES IN YOUR HOME

We use a private company that provides many different services to pregnant women upon our request. Home preterm labor monitoring, home fetal monitoring, terbutaline pump therapy for treatment of premature labor, home IV therapy for severe morning sickness, home IV antibiotics, and home nursing visits are some of the services provided. 

NON-STRESS TESTS

A non-stress test (NST) is a form of fetal monitoring, similar to fetal monitoring during labor. It is used to determine the well being of the baby, and also can be used to look for uterine contractions. This test is done for medical indications, and usually is done during the last 1-2 months of the pregnancy. It can be done here in our office and take about 30 to 60 minutes. 

 ACTIVITY RESTRICTION

We believe that your activity level should be as normal as possible unless there are medical benefits in restricting it. We have developed 5 levels of restriction (Level 1 is enforced bed rest, Level 5 is normal) as an adjunct in managing complications of pregnancy.  

BILLING CONSIDERATIONS

If an excess number of prenatal visits are required due to complications of your pregnancy, we may have to charge a "high-risk" fee. Please see the separate OB Fees Handout.