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Center for Women & Children's Health

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High Risk Pregnancies

Most babies are born healthy. However, about one out of ten pregnancies has a problem that affects the mother, the baby, or both. Sometimes these problems are genetic disorders passed from one or both parents to their children. Sometimes a fetus has birth defects and does not develop normally. Perhaps the mother has a medical condition or develops one that makes the pregnancy risky. Unfortunately, some problems can cause babies to die before they are born or shortly after birth.

Advances in prenatal and newborn medical care for these problems has greatly improved chances that mothers will deliver babies who will survive and lead healthy, normal lives. Close monitoring for high risk pregnancies by ultrasound and electronic fetal monitoring tests, more frequent prenatal care, and improved patient education can help prevent many problems or make them not so severe. If you have a medical problem before becoming pregnant or develop one during pregnancy that affects you or your baby, you may be advised to consult or transfer your care to a the medical center doctor who specializes in high risk pregnancies. These doctors, called perinatologists, are experts in managing problems of mothers and unborn babies, and they will work closely with your own doctor to do everything possible to make sure you and your baby remain healthy.

Problems in pregnancy can often be managed from home with more frequent visits to the doctor. Sometimes, it is necessary to put mothers in the hospital where they can be watched more closely 43and get help quickly if it becomes necessary. Remember, your doctors are experienced with pregnancies of all types and want only the best for you and your baby. They know that it can be very stressful to have pregnancy complications that require more trips to the hospital or long periods of time on bed rest at home or in the hospital.

It is important to realize that providing care for high risk pregnancies takes time. Many visits involve fetal testing such as electronic fetal monitoring and ultrasound. It is not unusual for high risk mothers to have NSTs and ultrasound weekly or twice a week. Lab work may need to be done more often, too. Your lab work can give us critical information and we may ask that you stay at the hospital until we get lab results that tell us it is safe for you to go home. It is not unusual to be at the office for several hours at a time. By asking you to keep more frequent appointments, we can often keep you out of the hospital and successfully help you manage problems at home. Please keep in mind that we don’t want to put you in the hospital if we can manage you safely at home.

At the medical center, we have a team of care professionals that will support you and your family through these difficult times, should that become necessary. This team includes nurses, nurse practitioners, social workers, and care managers in addition to prenatal doctors, OB/GYN residents, and neonatal doctors who are specialists in taking care of very small babies.

Some prenatal problems that may require consultation or transfer to a high risk prenatal doctor include:

  • High Blood Pressure
  • Toxemia (PIH, preeclampsia, eclampsia, or HELLP syndrome)
  • Diabetes and gestational diabetes
  • Heart, thyroid, lung or kidney disease
  • Epilepsy or other seizure disorders
  • Blood clot history
  • Premature Labor
  • Early rupture of membranes (bag of waters)
  • Vaginal bleeding especially in the 2nd or 3rd trimester
  • Poor fetal growth
  • Low or high amniotic fluid
  • Infections
  • Multiple pregnancy (twins, triplets)
  • Previous pregnancy problems
  • Mothers younger than age 15 or older than 35
  • Mental health problems
  • Drug use
  • Severe obesity
  • Abnormal fetal heartbeat
  • Rh factor problems
  • Placental problems

About the High Risk Perinatal Program

The Tennessee High Risk Perinatal Program (Tennessee Perinatal Care system) was established in 1974 as a High Risk Newborn Program by T.C.A. 68-1-801/804. It was expanded in 1977 to include high-risk obstetrics. The program focuses on the diagnosis and treatment of certain life-threatening conditions of pregnant women, fetuses and neonates.

Perinatal Center Services

  • Employment of perinatal outreach and support services personnel.
  • An emergency transportation system for transport of high-risk neonatal patients to the Regional Centers.
  • Equipment for the diagnosis and treatment of high-risk patients moms and babies.
  • Perinatal outreach education and in-service programs for physicians, nurses, and certain allied health professionals.
  • Consultation to physicians and nurses and social workers.
  • Evaluation of the Perinatal Program by a Perinatal Data System.

The Perinatal Regionalization System includes five designated perinatal centers which have implemented and individualized programs that address consultation, patient referral, communication, provision of specialized equipment, high-risk transport, in-service/outreach education for caregivers and site visits to local hospitals. The University of Tennessee Medical Center is one of these state-designated Perinatal Centers. Funding for this program has been appropriated through the State Legislature yearly since July of 1976.

The Perinatal Advisory Committee advises the Tennessee Department of Health regarding the state of perinatal care in Tennessee. Four sub-committees assist the PAC in this role. Personnel from each Center are appointed to the following committees:

  • Data Subcommittee
  • Liaison, Legislation and Funding Subcommittee
  • Regionalization, Care Levels and Professional Education Subcommittee
  • Perinatal Transportation Subcommittee

Regionalization Program Goals

  • To reduce perinatal morbidity and mortality associated with medically high-risk conditions.
  • To further the statewide development and implementation of the Tennessee Perinatal Regionalization Network.
  • To support and enhance the efforts of the Perinatal Advisory Committee and Subcommittees in their advisory role to the department.

For information, class registration, and/or tours of the facility please call us at 865.305.9300.