Expert advice on high-risk pregnancy

Eminent Swiss expert Prof. Dr. Breymann is recognised as one of the leading doctors in obstetrics. Here, he discusses the risk factors for a pregnant woman and what can be done to avoid harming mother and child.
Prof. Dr. Christian Breymann, MD is Senior Lecturer at University Hospital Zurich, a specialist in OBGYN and Feto Maternal Medicine and director of the Swiss Perinatal Institute. In this in-depth interview, he discusses the risk factors for high-risk pregnancy and the benefits of prenatal diagnosis.

Prof. Breymann, you are recognized as a top expert in the field of obstetrics. Which factors make a pregnancy a high-risk pregnancy?

Reasons to qualify a pregnancy as high risk pregnancy can be on the fetal or maternal side or both. On the mother‘s side, pre-existing conditions such as internal diseases (diabetes, thyroid, coagulation system) can complicate both the pregnancy and its outcome.

Some women have experienced complicated pregnancies or births in their past history, including heavy bleeding, preeclampsia or emergency cesareans that necessitate close counceling. Fetal high risk pregnancies are, for example, triplet pregnancies or pregnancies with fetal abnormalities such as heart defects, brain defects or genetic syndromes.

How can you help women with high-risk pregnancies ?

Help is based on various approaches which are partly medical but also psychological, especially in women who are afraid of complications. On the medical side we aim to think preventive, i.e. how can we prevent the risks and obstacles in your present pregnancy and how can we reduce your fear of it.

This includes some times even pre-conception counselling, nutrition counselling, early pregnancy counselling and making a plan and schedule for the course of pregnancy. In some cases, it also includes psychological support with experienced collegues.

We try to support  women on a one-to-one basis, which means that me and my team are there 24/7 for the patient from day to night until birth of the baby. We never delegate problems and use a close network of my institute.

We try to support women on a one-to-one basis, which means that me and my team are there 24/7 for the patient from day to night until birth of the baby.

Prof. Dr. Beymann

What are the benefits of prenatal diagnosis? Which conditions and disorders can be detected in a baby?

There is a vast range of benefits to prenatal diagnosis and numerous fetal conditions can be detected and even resolved or managed. Prenatal diagnostics are subdivided into invasive and non-invasive techniques. The most famous non-invasive test for fetal condition is ultrasound or fetal sonography using high- end resolution machines.

With these, it is possible to assess fetal size and weight, fetal sonoanatomy, organ perfusion, fetal circulation, placenta circulation, 3D and 4D imaginations. Other non invasive tests are based on biochemical testings from maternal blood, the latest one is the genetic test for down syndrome (trisomy 21) from maternal blood.

The main invasive tests are chorion biopsy and amniotic fluid collection for analysing the complete fetal karyotype. The benefits of all these procedures are mainly, to enable the attending specialist to diagnose and counsel the mother or parents and to help to understand a certain abnormal condition.

Based on that, the managment of a certain condition can be discussed and planned. For example, if a fetal heart failure or kidney failure is diagnosed prenatally, related specialist can be contacted already before birth to counsel the parents about the options in future life, and how to treat the baby. At birth, parents are already informed and do not experience a negative surprise.

How do you estimate the risks of prenatal diagnosis for the unborn child?

Risks in the sense of threatening the pregnancy by a special technique exist only for invasive testing such as chorion biopsy and amniocentesis. The statistical risk for a complication lies between 0.5-1%. However in experienced centers such as our institute the risk for a complication is below 0.5%. All depends on the experience of the performing specialist.

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