High-risk does not always mean you have or will develop complications. It does mean that your provider feels you have a higher likelihood of developing a complication then other patients. But even if you are high-risk, you may have a very uncomplicated pregnancy. It just means that your provider is aware of higher potential for complications and should provide appropriate monitoring in case complications do arise.
Medically complicated means that you or baby or both have known underlying conditions or problems that may mean some changes to your care. Your doctor may recommend running extra tests for either or both of you, seeing a higher level provider, and/or delivering by a certain point or in a certain way.
Should I be considered high-risk after preeclampsia? If my doctor says I am high-risk, does that mean they expect me to have complications again?
Yes, if you have had preeclampsia or another hypertensive disorder of pregnancy, you should be considered high-risk in all subsequent pregnancies. Again, you may have a completely uncomplicated pregnancy, and in fact, most women who have had preeclampsia do have uncomplicated pregnancies the next time. If your doctor says you are high-risk, it does not always mean they expect you will have complications, but it should mean they will be prepared in case anything changes.
What does a high-risk pregnancy look like?
This is going to be very individual. Your provider can review your obstetric history, fetal outcomes, underlying conditions, and so on and give a personalized monitoring and assessment plan for you. They can also decide if they want to refer you to a higher level of provider or hospital, and they can create a plan for delivery.
High-risk has a very wide range. For women who deliver at term, where baby and mom recovered quickly, no underlying conditions, high-risk may just mean their regular OBs do the recommended baseline testing and are just aware of their history and ready to act if anything changes. Except for baseline testing and perhaps home BP monitoring, their subsequent pregnancies may not look especially different from a low risk pregnancy.
For women who delivered preterm, who lost a baby, and/or who have certain underlying conditions, their subsequent pregnancies may be a little more busy. It is common for those women to have extra visits, sometimes with Maternal Fetal Medicine specialists or other specialists like cardiology. They may also have more ultrasounds, more NSTs, more lab work.
This chart is from the US's ACOG. It talks about the recommended monitoring and testing for women with a history of preeclampsia. There is leeway for individual situation, especially in the third trimester. Your plan will look specific to you!
My doctor said I am not high-risk and they will just proceed "as normal" unless anything changes.
This may be a matter of wording choice. As discussed above, you should be considered high-risk, but if your circumstances do not warrant extra tests and such, your pregnancy may not look very different from low risk. Use the above chart to discuss with your doctor how they will ensure that you and baby receive appropriate monitoring and any necessary care.
My doctor says I only need some baseline labs and a couple of ultrasounds. I see other women going to MFM, going for NSTs, and so on. Is my doctor doing enough to make sure baby and I are safe?
My doctor wants me to come in twice a week for two months, wants me to see MFM, etc. That seems like a lot – do I really need all of that?
Again, this is going to depend on your situation. Ask your doctor what they feel is appropriate for your clinical situation, as outlined in the chart. Ask your doctor what their concerns are for you and this baby and this pregnancy. Ask them what impact the results of certain tests would or would not have on your care and delivery plan. Informed consent means that you should be able to understand your doctor’s reasoning, and they should be able to understand your concerns, and in the end, you should both be comfortable with the plan and approach.
Here are some posts that can help you have a productive conversation with your doctor about how your care should look:
I just discussed the plan with my doctor, and that made the fear a little too real, and now I am worried and scared.
Hugs – pregnancy after preeclampsia is stressful, for sure. Many of us can relate to how you are feeling, and we are always here to listen and to lend a virtual shoulder. But we also recommend keeping your doctor informed about how you are feeling, emotionally as well as physically. They can help, by discussing pregnancy-safe anxiety meds and when those might be warranted. They can also refer you to a mental health professional who can help you develop some coping techniques for anxious moments. Postpartum.net also has some excellent resources.Specific information for those living in the UK
In the UK, as you don't have direct access to either an OB or MFM, your pregnancy will usually be placed on the
appropriate pathway when you book in with the community midwife. They will complete a risk assessment and score you on risk, which will include details of past pregnancies, losses and personal data. Your NHS trust will have a specific pathway detailing what your care looks like if you are high-risk, so make sure to ask your midwife. They will provide you with a list of appointments and with whom when booking in. If needed, you will be referred to MFM departments at a larger hospital if your pregnancy becomes medically complicated.