What Is Perinatology? Who Is a Perinatologist?
Perinatology, one of the first fields that comes to mind when discussing high-risk pregnancies, is a medical subspecialty that diagnoses complications occurring during pregnancy and initiates appropriate treatment plans. Specialists in this field are called perinatologists.
A perinatologist is an obstetrician-gynecologist (OB/GYN) who has completed further subspecialty training in Perinatology, also known as Maternal-Fetal Medicine or High-Risk Pregnancy.
What Is a High-Risk Pregnancy?
A normal pregnancy typically lasts about 9 months and results in the natural delivery of a healthy baby. However, not all pregnancies proceed without complications. A high-risk pregnancy affects both the mother and the baby and requires a different approach than standard prenatal care.
In such cases, patient follow-up is carried out not only by obstetricians but also by internists, dietitians, pediatricians, neonatologists, and especially perinatologists, who play a crucial role.
Perinatologists monitor the mother's condition during pregnancy and in the first month postpartum, conducting necessary examinations and diagnostic tests. For this reason, they are often referred to as high-risk pregnancy specialists.
What Are Considered High-Risk Pregnancies?
Any condition during pregnancy that poses a risk to the mother or fetus falls under the category of a high-risk pregnancy. If there is a potential for negative outcomes for either the mother or the baby, it should be carefully monitored by a perinatologist.
High-risk pregnancy classification includes:
Pre-existing maternal health conditions
Complications in previous pregnancies
Risks associated with fetal development
Issues arising during the current pregnancy
Risks that may occur during delivery
Perinatologists use regular monitoring and early diagnosis to minimize these risks and manage any abnormal developments promptly.
What Are the Causes of High-Risk Pregnancy?
One of the most important risk factors is the age of the expectant mother. If a woman becomes pregnant under the age of 17 or over the age of 35, the chances of complications increase. Pregnancies after age 40 carry a higher risk of miscarriage and other adverse outcomes.
Other causes include:
Chronic medical conditions such as hypertension, diabetes, kidney, heart, or lung disease
Autoimmune disorders
Sexually transmitted infections
History of miscarriage or pregnancy complications
All of these factors can negatively affect the course of pregnancy, leading to complications for both mother and baby.
What Risks Do High-Risk Pregnancies Pose for the Mother?
If the mother is under 18, her body may not be fully prepared to handle the demands of pregnancy. If over 35, she may develop conditions such as gestational diabetes or hypertension. Advanced maternal age also increases the risk of genetic abnormalities in the baby.
Additional maternal risks include:
Obesity (linked to preeclampsia and other complications)
Pre-existing chronic illnesses (e.g., heart, liver, kidney disease)
Immune system disorders
Past surgeries, especially involving the uterus (e.g., multiple C-sections or gynecological operations)
Infections during pregnancy, as the immune system is more vulnerable
What Are the Risks to the Baby?
The primary goal of prenatal care is to ensure the baby develops healthily and the mother remains safe. Several conditions may threaten the baby’s health, such as:
Macrosomia (birth weight over 4.5 kg), which increases delivery risks
Intrauterine growth restriction (IUGR), where the baby is significantly underweight
Poor placental blood flow, resulting in inadequate oxygen and nutrient supply
Abnormal levels of amniotic fluid (too much or too little)
Congenital, chromosomal, or genetic disorders
Such conditions can lead to premature birth, developmental delays, or life-threatening complications if not properly monitored.
How Are High-Risk Pregnancies Monitored?
The best way to ensure a healthy pregnancy is to begin preconception counseling. Ideally, a woman planning to conceive should consult an obstetrician, who may then refer her to specialists (e.g., cardiologists, endocrinologists) based on pre-existing conditions.
Once pregnancy is ed, monitoring typically begins at 6 weeks gestation:
Weeks 6–28: Check-ups every 4 weeks
Weeks 28–36: Every 2 weeks
Week 36 onward: Weekly visits
Monitoring frequency may increase for high-risk pregnancies.
Initial assessments include a review of the mother's medical and family history, screening for inherited conditions, and identifying previous pregnancy complications.
Routine testing includes:
Ultrasounds to examine fetal development
Blood and urine tests
Genetic screening (e.g., nuchal translucency, Down syndrome screening)
Gestational diabetes screening
Blood pressure monitoring
Tetanus vaccination (typically after 20 weeks)
Non-Stress Tests (NST) and amniotic fluid assessments in the final weeks
These frequent and detailed evaluations help reduce the risks and guide decision-making throughout pregnancy.