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Pregnancy is usually a serene time in a women's life. However, sometimes it
can be complicated by unexpected illnesses or some other medical conditions. When this
happens, the pregnancy becomes high risk pregnancy.
"High risk pregnancy" can mean anything from a multiple pregnancy to placenta previa
With the development of medical technology, pregnant women can
be carefully monitored for signs and symptoms of high-risk pregnancies.
What to do in case of high risk pregnancy?
A pregnant woman experiencing contractions, either painful or painless,
anytime during pregnancy, that occur more than four times an hour or are
less than 15 minutes apart should report this activity to her physician or
midwife, and be prepared to answer the following questions:
- When did the discomfort start?
- What is the type and frequency of the contractions?
- What were you doing when the symptoms began?
- Do you have any other signs or symptoms such as:
- Menstrual-like cramps that may come and go
- Abdominal cramps with or without diarrhea
- Backache that is dull and may radiate around toward the abdomen
- vaginal discharge increase or a noticeable change in color
- Pelvic pressure that is constant or intermittent
While waiting for her provider to return her call, the woman should:
- Lie down with her feet elevated
- Drink two or three glasses of water or juice
These two activities sometimes cause contractions to subside. If symptoms do
not lessen within one hour and the woman is not able to get in touch with
her health-care provider, she should go to the nearest hospital for further
evaluation.
Home Monitoring for High Risk Pregnancy
Home monitoring of the mother-to-be who has signs of pre-term labor may be
ordered by her health-care provider, especially if she must be on bed rest
for a significant time (often 20 weeks or more). Home care, although quite
expensive itself, may help reduce costs and continue to provide a safe and
satisfactory means of monitoring the pregnancy. Some insurance companies
cover the cost of home care visits and some aspects of home monitoring
equipment. Not all insurance companies cover home uterine activity
monitoring.
In the fall of 1990, FDA approved for marketing the Genesis Home Uterine
Activity Monitoring System to monitor uterine activity in women past their
24th week of pregnancy who have histories of previous pre-term births. The
purpose of such monitoring is the early detection of uterine activity, which
can cause cervical dilatation and pre-term labor.
Wearing an elastic belt around her waist, the expectant mother places the
transducer attached to the belt on her abdomen. The transducer is a small,
flat, pressure-sensitive recorder that looks like a "compact" or a small
"beeper" and detects uterine contractions. A computer program transfers the
data reporting the uterine activity over the telephone lines to
communication centers such as the obstetrician's office, the home health
service office, or a hospital relay station. Some women complain of skin
irritation from the belt and the transducer because the belt is worn for two
hours a day, usually one hour in the morning and one hour in the evening.
Drug Treatment for High Risk Pregnancy
Pregnant women at risk for premature labor are often placed on medications
that can stop contractions and give the fetus more time in the uterus. Such
medications are called tocolytic agents. The word is derived from the Greek
words tokos, meaning birth and lysis, meaning dissolution.
The following fictionalized example, based on several real-life examples,
explains the benefits of tocolytics.
Robin believes her 6-month-old daughter is alive and well today because of
the tocolytic drug treatment Robin received in her 22nd week of pregnancy.
Hospitalized for painful uterine contractions, Robin received tocolytic
medication intravenously. After one week, she was sent home on strict bed
rest, oral medication to prevent contractions, and a regimen of careful
monitoring.
The only tocolytic medication approved by FDA for use in pre-term labor is
Yutopar (ritodrine hydrochloride). Yutopar can be prescribed if labor begins
between 20 and 36 weeks gestation and if the fetus weighs between 500 and
2,499 grams (1 to 5 pounds). The initial dose of Yutopar is usually given
intravenously. Once the best dose for the patient is found, she may receive
the medication by oral or intramuscular route. The amount and frequency of
subsequent dosages depend on the woman's response to the initial therapy.
Yutopar should not be used in women who have cardiovascular disease,
pregnancy-induced high blood pressure, intrauterine infection, vaginal
bleeding, or uncontrolled diabetes. Nor should it be used if the woman is in
active labor or has a history of repeated miscarriages due to an incompetent
cervix, or if the fetal membranes have ruptured.
Side effects include: heart palpitations, excessively rapid heartbeat,
tremors, anxiety, headaches, vomiting, and fever.
Low blood sugar, bowel problems, and a low level of calcium in the blood
have been reported in infants of mothers who were given tocolytics such as
Yutopar.
The labeling instructs physicians to carefully weigh the risks and benefits
of administering the drug to women who are more than 32 weeks pregnant
because of its possible effect on the fetus.
An electrocardiogram is recommended before starting Yutopar therapy. Before
and often during tocolytic therapy, the patient may be monitored for serial
blood glucose and blood electrolyte levels.
When a woman in pre-term labor also has diabetes or heart disease, she may
be placed on magnesium sulfate to reduce uterine activity. Magnesium sulfate
is approved for magnesium deficiency states but not specifically for use in
pre-term labor. However, because there is extensive literature and clinical
data on this use, some physicians prescribe it. The most uncomfortable side
effect of magnesium sulfate is a feeling of warmth and flushing when the
drug is first administered. Women must also be carefully monitored for
respiratory or cardiac complications during the therapy.
Terbutaline sulfate, a drug approved for asthma and other lung disorders,
has been used by some physicians to treat pre-term labor. However, it has
not been approved by FDA for this use, nor has the agency been asked to
review an application for marketing terbutaline sulfate for treating
pre-term labor. The labeling for terbutaline sulfate was revised in 1988 by
the drug's manufacturer to specify that it is not approved for treatment of
pre-term labor.
Health professionals hope that proper use of home monitoring will lead to
more appropriate and effective use of tocolytics.
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