High-risk pregnancy

Dr Richard Murphy

High-risk pregnancy

If your pregnancy is high-risk, then you can count on my extensive experience to help you make the best decisions, and to help you manage the risks. Whatever the causes of your high-risk pregnancy, you will get careful monitoring, a clear explanation of any of ultrasounds and tests and coordination with any other specialists involved in your care. On this page we discuss the connection between IVF and high-risk pregnancies, as well as the typical FAQs you may have in regards to high-risk pregnancy management.
Obstetrics and gynaecology consultations at my private practice in Subiaco.

Fertility consultations at Genea Hollywood Fertility

Delivering at the Labour Ward of SJOG Subiaco Hospital

Perth obstetrician for high-risk pragnancies

What is a high-risk pregnancy?

Both older and younger mums may have higher risks of pregnancy complications.

Pre-existing medical conditions such as

  • epilepsy,
  • diabetes,
  • high blood pressure,

increase the risk in a pregnancy.

Your family history can also have an impact on how your pregnancy goes. There is a link between any difficulties you may have had falling pregnant, any previous pregnancy losses, either miscarriage or stillbirths, and the risk of complication in your current pregnancy. This is where you deserve to have an unrushed consultation, where I create the space to look at your medical history and your fertility journey.

IVF treatment can be the reason why your pregnancy is labeled as high-risk. Fertility treatment is associated with a small increase in the risk of complications such as bleeding or early delivery.

"It is perhaps easier to define what a low-risk pregnancy is. Mothers aged 18-35 who are fit and healthy, conceived easily, are not overweight, do not smoke, drink alcohol or use drugs and without significant personal or family history, form the lowest risk group of women in pregnancy."

Dr Richard MurphyPerth obstetrician
high-risk pregnancy perth

All risk factors for complications in pregnancy are additive, some more so than others. In other words, they do add up and that is why taking the time to work out a personalised journey for your pregnancy is so important. This is also why I consider it my role to build a relationship with you, so we can manage the test results and the information together, and so you have a clear view on where you are at.

The exact degree of risk for your pregnancy will depend on your unique combination of risk factors. We will collect history and test results to help make well-informed choices.

High-risk pregnancy Obstetrician

Becoming high-risk during pregnancy

Every pregnancy needs careful monitoring. You will be offered screening for chromosomal abnormalities with either a First Trimester Screen or a NIPT (Harmony) test and detailed ultrasounds will look for abnormalities with your baby’s anatomy.
You will also be screened for signs of a short cervix, one of the biggest risk factors for early labour. As your pregnancy develops there is the possibility that preeclampsia, gestational diabetes or fetal growth restriction develops.
Any of these conditions will make your pregnancy high-risk. While we want you to be aware of risks, we also want to make sure that you go through your pregnancy in a calm and confident way.

Healthy pregnancy

Minimising high-risk in pregnancy

Optimising your health and that of your partner before conceiving is important. Simple things are important, like
  • regular exercise,
  • good mental health,
  • avoid caffeine,
  • not smoking,
  • not drinking,
  • not using illicit drugs.

Folic acid (500mcg or more) will help your baby’s neural tube (developing brain and spinal cord) develop properly and should be taken from 3 months before you start trying to conceive until week 12 of your pregnancy. If there is any history of neural tube defects in your family then high dose folic acid (5mg) is best.

We should not forget the role a man’s health plays in the success of a pregnancy. 50% of the genetic material for a baby comes from the father so ensuring his sperm has the highest quality DNA is vital.

Age & pregnancy

Age and high-risk

Age is always important in pregnancy. It is the number one factor in determining egg quality. A woman is born with all of the eggs she will ever have, so as she gets older, so do her eggs. Older eggs are more likely to produce pregnancies in which the chromosomes are abnormal. If an extra chromosome 21 is present the pregnancy has Down’s syndrome. Most chromosomal abnormalities either do not produce recognisable pregnancies (you would never know that you have been briefly pregnant) or result in miscarriage. Egg age explains the rapid drop in female fertility from the late thirties onward.

Once a woman is in her early forties she is also more at risk of pregnancy complications such as preterm rupture of membranes, preterm labour, preeclampsia and gestational diabetes.

An older male partner will also increase the chances of complications in pregnancy and this is often additive to the risks associated with older mums.

Twins Obstetrician

Twins and high-risk

Twins’ pregnancies can be delightful. I have twin nephews myself who are gorgeous boys. Not all twin pregnancies are the same though. Monochorionic pregnancies, sharing a placenta, have a 15% chance of twin-twin transfusion syndrome (TTTS) and require expert monitoring and care. All twin pregnancies are at increased risk for early delivery and preeclampsia. Vaginal twin delivery can be an amazing experience and can be done safely in most cases. Where possible I try for vaginal twin delivery.

Visit AMBA, Australian Multiple Birth Association, for more information

Perth obstetrician for ivf pregnancy

IVF and high-risk

IVF confers a small additional risk to your pregnancy over and above the risks associated with subfertility or infertility. All pregnancies are special, especially those that have not come easily. It is rare that an IVF pregnancy has no other risk factors and so they are almost always high-risk.

"I hope that as you gain confidence in your body and your pregnancy you can start to relax and properly enjoy your pregnancy. This usually happens early in the second trimester. From that time on you we will monitor you and monitor your baby’s growth and plan for your delivery."

Managing previous high-risk pregnancy

Previous high-risk pregnancy

The concept of the “near miss” is very important in Obstetrics. I am always interested in what has happened in previous pregnancies because often similar disorders or processes will recur. Even more importantly, sometimes simple interventions either before or early on in a pregnancy can significantly reduce the chances of recurrent problems.

"Managing risks is all about knowing your history. For example, if you have had preeclampsia during your previous pregnancy, we will use aspirin in your current pregnancy."

Dr Richard MurphyPerth obstetrician
With intrauterine growth restriction, investigation for antiphospholipid syndrome is important. If you have had gestational diabetes, this often recurs, especially if controlling your sugars was difficult.

FAQs high-risk Pregnancy

I am high-risk: FAQs

Will I be closely monitored?

During the course of your antenatal care I will be constantly trying to preempt problems before they develop.

"The aim is to detect and treat any significant problems as early as possible. High-risk pregnancies will need more intensive monitoring than low risk pregnancies. This may involve extra ultrasound or Cardiotocograph (CTG) monitoring."

You may also need to see other Specialists such as a Dietitian, Obstetric Physician, Neonatologist, Anaesthetist, Haematologist etc through the pregnancy.

Will my baby be healthy when I am high-risk?

The guiding principle I have for all Infertility and Obstetric care is the delivery of a healthy baby, aiming for full-term delivery. We want a baby who can grow to their full potential as an adult. Modern antenatal care provides the best chance of detecting any problems so that you have the necessary information with which to make decisions for you and your baby.
The biggest single risk to the long term wellbeing of otherwise normal babies is preterm birth and preventing this is critical. The vast majority of babies, even with very high-risk mothers, are healthy and thrive.
For the vast majority of babies there is no extra safety in delivery by Caesarean section. Even for high-risk pregnancies, vaginal delivery is usually preferable.

Is a high-risk pregnancy the same as a high-risk birth?

There is a link between the risk level of a pregnancy and how much risk there will be in the delivery. For most uncomplicated, term pregnancies there is no safety benefit to you or your baby by having a caesarean delivery. Even for preterm deliveries and growth restricted babies, where there can be preeclampsia or other pathology, vaginal delivery is usually preferable.
I want your delivery to be as safe and enjoyable as possible. Remember, bringing a baby into the world is usually a time of great joy. If there are any reasons why you are likely to not labour well I will discuss these with you remembering that for a number of women caesarean delivery may be the best option.

Experienced Perth obstetrician for high-risk pregnancies

Why Dr Richard Murphy as your high-risk obstetrician?

Firstly… I really enjoy Obstetrics and I hope that most couples can enjoy the experience of pregnancy, delivery and starting a family as positively as possible.

With expert and specialist care, you will get the best possible outcome for both you and your baby.

My wife and I lost our first baby at 25 weeks. This was the most awful time of our lives. I work hard to prevent this happening to any other parents. It has given me a very deep understanding of the risks, both medical and as a human being.