High-risk Pregnancy Care
A high-risk pregnancy is one that involves an increased level of risk to the mother, the baby or to both. Women with a high-risk pregnancy may need to be seen more frequently during their pregnancy to ensure that they and their baby are in the best health throughout the antenatal period. You can trust the Alana Obstetricians to provide you and your baby with the level of care and support that you need.
Maternal high-risk pregnancy
Various maternal factors may make a pregnancy high-risk such as advanced maternal age (over 40 years), maternal diseases like high blood pressure, diabetes, epilepsy, clotting abnormalities, previous uterine surgery such as previous caesarean delivery or myomectomy (surgery for fibroids), and many more. Your Alana Obstetrician will take a full medical history at your booking visit and will make a plan for your antenatal care with these risks in mind.
Fetal high-risk pregnancy
Your baby can also contribute to making the pregnancy high risk. Examples include intrauterine growth restriction (IUGR) where the baby is smaller than expected for the dates, fetal anomalies which may be detected on ultrasound throughout the pregnancy, twin or triplet pregnancies, or problems with the location of the placenta (placenta praevia).
Frequently Asked Questions
How much does antenatal care at Alana cost?
For Medicare eligible, privately insured patients, you can read our full Obstetric Fee Disclosure
. If you are Medicare ineligible and/or don’t have private health insurance, please telephone us on 02 9009 5255 and we can provide you with the relevant fee information.
Why do I need to have an ultrasound during my pregnancy?
Ultrasound can take high quality images of many parts of your body, which makes it an excellent diagnostic tool. During pregnancy, an ultrasound is recommended for a number of reasons:
- For confirming the age of the baby and to predict the due date;
- To look at the baby as it develops throughout the various stages of pregnancy;
- To screen for chromosomal and other abnormalities (such as Down syndrome).
Is having an ultrasound safe for my baby?
Ultrasound has been used in obstetrics for over 50 years. Ultrasound services provided to you in the context of your pregnancy care follow the ALARA (as low as reasonably possible) principle and the recommendations of The Australian Society for Ultrasound in Medicine. This means that we will only perform an ultrasound when indicated, and minimise the exposure time and intensity. We have written more about the use of ultrasound in pregnancy in our blog .
What are my chances of falling pregnant after an ectopic pregnancy?
It depends. Some ectopic pregnancies are caused by certain conditions like endometriosis
or as a result of previous pelvic inflammatory disease (PID) commonly caused by Chlamydia infection. In these conditions the remaining fallopian tube may be scarred and increase the likelihood of another ectopic pregnancy. In general, the risk of recurrence is up to 8-10% after one ectopic pregnancy. The recurrence risk is of course dependent on whether or not you have any underlying conditions. Many women (and doctors) think that the ovaries are taking turns in releasing an egg (left than right etc.) but this is not true. The other commonly held belief is that, for example, the right fallopian tube only can pick up the egg released from the right ovary, which is not true either. We know that in reality the ovaries are located rather close to each other (not like in the anatomy pictures), and ovulation occurs more “randomly” from each ovary (sometimes at the same time!) and that the fallopian tubes can pick up the egg from the ovary on the other side. This is because of a complex process attracting the fallopian tube to move towards the ovary where the ovulation (release of the egg) has occurred.
Therefore a previous ectopic pregnancy doesn’t half your chances of a next pregnancy. Research has shown that around 65% of women with a previous ectopic pregnancy have an intrauterine pregnancy within 18 months. This figure may go up to as high as 80% in two years, so that is promising. If you do fall pregnant it is important to have an early pregnancy scan determining the location of the pregnancy, making sure it is inside the uterus.
If you have trouble falling pregnant than depending of your age and underlying conditions we would recommend you to see one of our Alana specialists as the other fallopian tube may be scarred and preventing you from conceiving naturally. There is an ultrasound test called a HyCoSy (“Hysterosalpingo Contrast Sonography”) which can determine whether your other fallopian tube is functioning normally. During this ultrasound investigation a speculum is inserted to allow a thin plastic tube to be placed inside the uterus. Through this tube a mixture of air and normal saline is injected and this shows up on the ultrasound scan. You can see if the fallopian tube is open (“patent”) as there is spill seen around the end of the fallopian tube and ovary. This test may reassure you if normal. If the fallopian tube is blocked it is worthwhile seeing one of our fertility specialists
at Alana who will discuss alternative ways for a pregnancy to occur
How long do I have to wait after my miscarriage to try to conceive again?
We recommend you have at least one normal period after your miscarriage. If the first bleed is not quiet as normal than wait until you have a normal menstrual period in your next cycle as it takes time for your body to clear the pregnancy hormone. When you have had a normal period we know your cycle has returned to normal, the pregnancy hormone is out of your system and that your body is ready for a new pregnancy. Record the first day of your menstrual period (LMP) as this is important in dating your next pregnancy. Physically you do not need more than one period but allow yourself enough time to emotionally be ready as well. Some time is also necessary to allow yourself to grieve about your pregnancy loss.
We find that most women after a miscarriage are a little more anxious in their next pregnancy. Your GP can refer you to the Alana Obstetricians
for an early pregnancy scan and we recommend it to be done at around 8 weeks from your LMP as at this stage you should really be able to see your baby’s heartbeat.
I thought I was 7 weeks pregnant but the scan says I’m only 5 weeks and no heartbeat is seen, how is this possible?
To answer this question we firstly go back to basics to understand your cycle.
The pregnancy is calculated based on the average menstrual cycle which is 28 days. The first day of menstrual bleeding marks the first day of the menstrual cycle. This is called your LMP (or “last menstrual period”). Right in the middle of this picture perfect 28 day cycle is when ovulation occurs (day 14 of the cycle) and roughly 2 days before and after is when you are most fertile. In real life not everyone has this picture perfect 28 day cycle, it may be longer or shorter, but we know that ovulation occurs roughly 14 day before
your next period. This is why many fertility doctors
recommend to have intercourse every 3 days if you really are trying to have a baby because the ovulation may occur a little earlier or later than you may think.
When calculating the weeks of pregnancy we include those two weeks from the first day of the LMP as this is the easiest part of the cycle to notice and to record. We also will enquire about the length of your cycle and whether it is regular or irregular. All of this is helpful in trying to establish the gestation. For example, if your cycle is regular and 33 days long we would expect your ovulation to have occurred later (5 days) and an early pregnancy scan will most likely show a baby that measures 5 days less than you were expecting.
Now to answer your question, it may be that you ovulated later in the cycle or have a longer cycle. The pregnancy is truly only 5 weeks, a follow up ultrasound in 10-14 days is likely to show your baby’s heartbeat and all is well. The other possibility is that unfortunately the pregnancy is not developing as expected at 7 weeks gestation and a follow up scan may reveal a miscarriage. We understand that this is an anxious time and to have to wait for 10 -14 days seems very long but it is important to have this time in between scans to determine accurately what is taking place.
Why do I have spotting or mild bleeding in early pregnancy?
It is common to have some bleeding in early pregnancy. It may occur in 20% (or one out of five) mums to be, and it is unlikely to be harmful to your baby. It usually happens at about the same time that your period would have been due, and may last for a couple of days. The bleeding is usually light (no large clots) and is not accompanied by strong period pains.
There are many different causes for bleeding in pregnancy, and in the first trimester the bleeding may be caused by:
- Breakthrough bleeding: which happens as the pregnancy hormones interfere with the hormones of your normal menstrual cycle. This causes some the endometrial lining to be shed. Spotting or light bleeding may come and go for several days.
- Implantation bleeding: which happens when the fertilised egg implants in the endometrial lining of the uterus. The endometrial lining has been prepared for the nestling of the fertilised egg during the menstrual cycle and has now got a very good blood supply. The implantation may therefore be associated with some light bleeding.
- Other causes: which may include changes to your cervix by the pregnancy hormones; it softens the cervix and causes an area of cells covering the cervix to move towards the outside of the cervix. These cells are more prone to bleeding, especially when touched during intercourse. It is important to be up to date with your Pap smear screening tests as bleeding may also be caused by abnormal cells. Bleeding can also be linked to vaginal or cervical infection which would require further investigation with a vaginal swab and may need treatment. A harmless growth on the cervix called a polyp may also cause bleeding at any stage in the pregnancy. A speculum examination (as is done with the Pap smear) will reveal this polyp, and usually nothing needs to be done about it during your pregnancy.
Bleeding in early pregnancy is common but it’s important to tell your doctor about it. At Alana we will perform a physical examination which may include a speculum examination to see if the cervix is open or not and what the cervix looks like in general. Depending on other symptoms we may take a vaginal swab if we think there is an infection. We may also perform an (internal) ultrasound to measure the gestation and to determine where the pregnancy is located.
We would recommend testing your pregnancy hormone level (“quantitated HCG”) which also helps in dating the pregnancy, and we would test your blood group.
In general if the bleeding is light and settles down, and is not accompanied by bad period type pains, there is a good chance that all is well and that your baby is fine.
When should I book in to see my obstetrician?
We usually see you for your first antenatal visit between 8-10 weeks of the pregnancy, but in some circumstances you may need to come in earlier. If you are experiencing severe early pregnancy symptoms, have bleeding or pain, or are uncertain of how far through the pregnancy you are we can see you as early as required. Alternatively, if you find out that you are unexpectedly further along in a pregnancy you can book in as soon as possible.
Do I need to have an ultrasound before I attend the clinic?
No, an ultrasound will be performed at your first visit to confirm the dates while you are seeing your obstetrician. If there are any concerns, we may refer you for a formal ultrasound.
What do I need to bring to my first antenatal appointment?
Your referral letter from your General Practitioner plus any antenatal screening bloods and/or scans that you have had performed, as well as any relevant medical history including medications. You should also bring your Medicare card and private health insurance details.
Where will my baby be delivered?
The Alana Obstetricians deliver exclusively at the Prince of Wales Private Hospital in Randwick, located in the Eastern Suburbs of Sydney, where you will receive excellent and personalised birthing care
Who will attend my delivery?
A familiar face! The Alana Obstetrician
on call will attend your delivery. While this may be your primary Obstetrician who has cared for you throughout your pregnancy, it may also be one of the other Alana Obstetricians who you will meet at planned visits throughout the course of your antenatal care. This means that you will never have a stranger attending you when you go in to hospital.
What is the cost of private antenatal care at Alana Healthcare?
Our full fee disclosure is available here
What should I do if I need medical assistance during my pregnancy?
Once you have booked your antenatal care with us, you have access to medical assistance 24 hours a day, 7 days a week. If at any stage you feel something is not right, telephone us at any time of the day or night on our emergency number 0499 525 000. If you are beyond 24 weeks gestation telephone either us or the Prince of Wales Private Delivery Suite on 02 9650 4444.
How long will I be in hospital for when I deliver my baby?
If you give birth via vaginal delivery, your hospital stay will generally be 4 nights/5 days. If you give birth via caesarean delivery, your hospital stay will generally be 5 nights/6 days. If you are admitted after midnight that counts as day 1 not as night 1!
Following the birth of your baby at the Prince of Wales Private Hospital you do have the option of moving to the Crowne Plaza Coogee Beach as an alternative to in-hospital care to recover and get to know your newest family member. There is a midwife on site 7 days a week, the rooms all have ocean views and your partner can stay with you. For more information visit the Prince of Wales Private website
What do I do if I am experiencing hand/wrist pain during my pregnancy or after the birth?
Correct diagnosis of a hand or wrist condition is important when considering appropriate management. An early diagnosis allows for early intervention, which will favour promising outcomes.
The Alana Physiotherapists are trained to identify the cause of your hand and wrist pain, and to assist each woman throughout her recovery. An appointment can be made with the reception staff and does not require a doctor’s referral.