Are pregnancies after losses considered high-risk in general?

JCM285 · February 2014

This is really just a general question. I know that all of us have gone through different experiences, so our answers would naturally be different. My point is that with a pregnancy after a loss, should I be considered high-risk and what does that mean exactly? I tried to Google it, but every source gives different (and sometimes conflicting) information. Some of the sites say that anyone who experienced pregnancy and a loss should be considered high risk the second time around automatically. Meanwhile, other sites say that every pregnancy is different and high-risk can only be determined if the specific pregnancy poses any problems. My situation last year was a partial molar pregnancy, and the doctor suspects that it was due to 2 sperm fertilizing 1 egg, although he wasn't able to confirm it. He told me that it was more like a "fluke" than a problem that is likely to happen again. The only risk I had (since my betas dropped every month) would have been if I got pregnant after the loss within 6 months or so, which I did not. Therefore, I figure that I'm probably not applicable for the high-risk designation. Does anyone know what being high-risk really means? I hope that I am not offending anyone who knows that she is high-risk, because I truly don't know what it means. I am just trying to figure out what might be important to ask during my pre-natal appointment. Thanks girls!!

MsAmandaPants · February 2014

No, as I understand it, a prior loss does not necessarily translate to higher risk pregnancy. Most post loss moms go on to have normal pregnancies.

If there is an underlying, significant health condition that caused the first miscarriage, however, THAT could contribute to being high risk, but that is not the case for the majority of losses (i think most first miscarriages are attributed to spontaneous chromosomal abnormalities or something went wrong when sperm met egg).

Regarding your partial molar since you waited the appropriate amount of time, I think the only other possible risk is that it puts you with a fairly minuscule heightened risk of having another molar . However, as I understand it, it has absolutely no bearing on the outcome of a normal pregnancy and does not make you high risk. If your doc has already confirmed that this is a normal pregnancy, you should be fine in that regard.

ETA: hit post too soon and clarifying...I would simply ask your doc if there is anything in your medical record that would lead them to believe that you might be high risk. No harm in asking, but they will also tell you if they are concerned.

Also adding that I have had one miscarriage and one complete molar pregnancy and my doctor did not consider me high risk with this new pregnancy.

ball.and.chain · February 2014

I think it depends on your loss. With 2 first tri losses under my belt, my OB does not consider me high risk.

[Deleted User] · February 2014

It depends on the loss. Early miscarriages usually are not indicative of high-risk. I imagine a 3rd tri loss would be different, depending on the doctor. I had an ectopic and they will bring me in for a viability u/s but I'm not considered high risk.

JCM285 · February 2014

Thank you for all of your insight! This makes a lot of sense. I feel better going into my appointment. It's not until the 24th but it's still going to be a scary day. I appreciate your responses. @MsAmandaPants, thank you always. You were the first person to relieve my fears in the other forum and now this one too. You are the best and I'm happy to hear that the doctor does not consider you high risk!! My doctor hasn't confirmed anything yet, because I haven't been in to see him yet :-/

buggirl72 · February 2014

*lurking*

As others have said, it depends on the loss. I had a loss at 20 weeks (PTL) which automatically moves me to a high risk status on any subsequent pregnancy and will put me under the care of a MFM if I can make it past 8 weeks.

dragonfly711 · February 2014

I am 40 and I had a loss last Feb at 11 1/2 weeks. I am not at high risk. I have had a few more US but I believe more because I am older than anything else. My Dr does not seem too worried.

SandSunBliss · February 2014

I also had a second tri loss and it placed me in the high risk category with "poor Ob history". That's fun to see every appointment. I have extra risk because of my family history of diabetes although I don't have it.

I don't mid being high risk, because the status allows m OB to be very thorough without too many insurance concerns. So far, this pregnancy has been normal but I did get an extra glucose test and some additional ultrasounds and blood tests.

MsAmandaPants · February 2014

JCM285 said:

Thank you for all of your insight! This makes a lot of sense. I feel better going into my appointment. It's not until the 24th but it's still going to be a scary day. I appreciate your responses. @MsAmandaPants, thank you always. You were the first person to relieve my fears in the other forum and now this one too. You are the best and I'm happy to hear that the doctor does not consider you high risk!! My doctor hasn't confirmed anything yet, because I haven't been in to see him yet :-/

You are welcome! I know how scary molars are. I was referring to early miscarriages with my first response; as other posters have rightfully pointed out, later term losses are a whole different matter. However, since you have just had the one partial molar pregnancy, I would guess that your doc won't consider you high risk (unless you have other health stuff going on that you haven't shared), but definitely ask him some pointed questions. The chances of another molar, while slightly heightened after having had one, is still really, really, really low. I've got everything crossed for you! When is your first appointment? Keep me posted.

stefuge · February 2014

::lurking:: I think it depends on a lot of things, as PP said. I lost my son at 32 weeks, and have been told I would be considered high risk with any future pregnancies, no question. I think this is normal with third tri losses.

Junebug060609 · February 2014

My two losses (both 1st tri) dont make me high risk. My age (37) and a history of Pre-Eclampsia do.

There are some cases where the cause/type of loss could make à person high risk though. Later losses, IC, clotting issues come to mind.

buggirl72 · February 2014

dragonfly711 said:

I am 40 and I had a loss last Feb at 11 1/2 weeks. I am not at high risk. I have had a few more US but I believe more because I am older than anything else. My Dr does not seem too worried.

Even though your OB does not consider you high risk based on your age alone, I absolutely encourage you to ask to be co-monitored by an MFM. Your age does put you in a high risk category. I'm trying to word this so I don't add to PgAL fears but I am speaking from experience in having been 40 with my first pg, completely healthy, and having an OB who felt that I was not at risk because I was so healthy. My pg was uneventfull until the day it wasn't and I kick myself for not asking to be under the care of an MFM also.

JCM285 · February 2014

Thanks everyone! I think I learned that there are actually no specific rules in doctors considering you high risk, but there are a ton of factors. I completely understand losses later in the pregnancy causing you to be considered high risk, and I am so sorry for your losses! I also didn't know that you can go from low-risk to high-risk and vice versa, although that makes sense. My doctor told me during one of my post-D&C appointments last year that I would probably have additional ultrasounds if I got pregnant again to rule out another PMP, but I am thinking that does not exactly make me high-risk. @MsAmandaPants, my appointment is 2/24. I will definitely keep you posted. Thank you ladies!!!

Junebug060609 · February 2014

buggirl72 said:

dragonfly711 said:

I am 40 and I had a loss last Feb at 11 1/2 weeks. I am not at high risk. I have had a few more US but I believe more because I am older than anything else. My Dr does not seem too worried.

Even though your OB does not consider you high risk based on your age alone, I absolutely encourage you to ask to be co-monitored by an MFM. Your age does put you in a high risk category.

I'm trying to word this so I don't add to PgAL fears but I am speaking from experience in having been 40 with my first pg, completely healthy, and having an OB who felt that I was not at risk because I was so healthy. My pg was uneventfull until the day it wasn't and I kick myself for not asking to be under the care of an MFM also.

Speaking as an AMA'er here. Bug is right. I am not seen by an MFM, but my docs are extra watchful. Outwardly, I am treated like other patients, but both they and I are extra vigilant for complications.

kmbk27 · February 2014

Like so many others said, I think it is situationally specific. I had one first trimester loss, and while I think my OB's office has been a little extra observant with this pregnancy, my US order last time still said "supervision of normal pregnancy". It was strange to see that because no matter how well things go with this pregnancy (and any future pregnancies), I don't think one will ever feel "normal" after what I went through with my first.

I hope the time flies between now and your appointment!

dogsombrero · February 2014

I have had 2 early losses and I did see an MFM until 13 weeks/NT scan. In the beginning I was considered "low-risk high-risk" according to him based on history. Once the NT came back good he said I was just like any othe patient a total normie. I've never been more happy to be average.

knirish1 · February 2014

I lost my daughter at 40 weeks due to a cord knot. I'm now 23 weeks pregnant and not considered high risk. I had all the tests done after her loss to make certain that there was no underlying problem other than the knot, and they all came back clean. It was a horrible accident. Since I had a very healthy pregnancy otherwise last time, my doctor has said I'm not high risk. I am having some additional monitoring later in the pregnancy, but that is more for my peace of mind than anything.

sunflwra · February 2014

***lurking***

Hoping to join you ladies soon. Just had to say thanks for this post. I had a healthy 1st pregnancy other than being induced at 38.5 weeks for increased blood pressure. I then had a loss at 20 weeks. We believe it was due to a cord accident and was a fluke (had genetic testing done early with no problems) but are still waiting for the autopsy results to rule out anything else. I was wondering if I would be considered high risk in subsequent pregnancies or not based on that. Also wasn't sure what type of extra monitoring I may be able to request even if I'm not considered high risk. This has been hugely helpful!

mileswithmyles · February 2014

I had one early loss and they considered me high risk until after my 8 week appointment when everything looked like it was going to be healthy. The only difference was that they saw me twice before I was 8 weeks to do ultrasounds.

Xath · February 2014

I'm considered high risk this time around because they were never able to figure out what caused me to go into PTL with my daughter (I had no warning symptoms). After my anatomy scan when everything looked normal, we downgraded to "normal" pregnancy monitoring (though I still was on Makena P17). But when I went into PTL at 24 weeks, I got bumped back up right away.

I think it depends on when your loss was and what caused it.

angelsnight · February 2014

It depends on the type of loss, and whether or not the reason for the previous loss(s) could impact a future pregnancy. For example, my loss was at 22 weeks because I went into PTL due to possible incompetent cervix. If that was indeed what I had (they can't be certain but strongly suspect) there is every reason to believe my cervix could be incompetent for all future pregnancies so I needed more monitoring and I had a cerclage put in, which is only done by an MFM and also needed to be monitored by her.

I am not very familiar with a molar pregnancy, but from what I understand there is nothing that can be done for one, so extra monitoring would not do any good for another one, so there is really nothing an MFM could do that a regular OB couldn't. Good luck!

Third&goal · February 2014

I think in general, no, it does not make you high-risk.

But if you've got even just one late-term loss, then yes, I would assume you would be high-risk.

Luckie519 · February 2014

I have had 3 losses and am not considered high risk. I do consult with a high risk doctor every so often, but no one has labeled me as high risk. We have had some close calls with different issues and kept waiting for that label, but so far so good!

Good luck to you!

megaddie · February 2014

I'm labeled high risk after two losses but that might be because I'm also 37...and extremely anxious. Also, I had a sister with Down Syndrome, which I know isn't generally inheritable, but that seemed to push them to label me as such. I'm also taking progesterone...

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