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¿Qué es Embarazo de Alto Riesgo?

Definición
Casos en los que, por coincidir durante la gestación, en el parto o en el neonato circunstancias sociales, médicas, obstétricas o de otra í­ndole, se acompañan de una morbimortalidad perinatal superior a la de la población general. Por ello es prioritario identificar precozmente los factores de riesgo y estimar su importancia relativa en relación con el resultado perinatal para poder disminuir así­ las consecuencias adversas de los mismos.

Factores de riesgo
Es aquella caracterí­stica o circunstancia identificable en una persona (embarazo, parto, feto y/o neonato) o grupo de personas que se asocia con un riesgo anormal de poseer, desarrollar o ser especialmente afectado de forma desfavorable por una enfermedad. Se consideran cuatro grandes grupos:

Sociodemográficos: se identifican en la consulta prenatal. Es el grupo donde existen las mayores discrepancias por los distintos autores.

Antecedentes médicos: la asociación hipertensión materna más gestación es una de las principales causas de muerte materna así­ como de muerte fetal, crecimiento intrauterino retardado, abruptio placentae y sufrimiento fetal agudo. Su detección y tratamiento precoz mejoran el resultado perinatal y disminuye las complicaciones maternas. En este apartado tienen mayor importancia los individuos predispuestos o con enfermedad latente, ya que son los que con mayor frecuencia no son valorados de forma adecuada.

Antecedentes reproductivos.
Embarazo actual: como proceso dinámico que es, deben valorarse los factores de riesgo que vaya surgiendo a lo largo del embarazo.

Niveles de detección de riesgo

Riesgo bajo
Gestantes en las que no se han podido identificar ninguno de los factores de riesgo que se detallan en los niveles siguientes.

Riesgo medio (I)
Anomalí­as pélvicas
Cardiopatí­a I grado
Condiciones socioeconómicas desfavorables
Embarazo no deseado
Estatura baja
Control insuficiente de la gestación
Esterilidad previa
Fumadora habitual
Edad inferior a 17 años o superior a 38años
Gestante Rh-
Gran multiparidad
Incremento excesivo o insuficiente de peso
Obesidad no mórbida
Riesgo de ETS
ITU o bacteriuria asintomática
Riesgo laboral
Metrorragia 1º trimestre
Periodo intergenésico inferior a 12 meses

Riesgo alto (II)
Anemia grave
Cardiopatí­a grado II
Cirugí­a uterina previa
Diabetes gestacional
Embarazo gemelar
Endocrinopatí­a
Obesidad mórbida
Preeclampsia leve
Infección materna:
VHB-VHC Lues
Toxoplasmosis VIH
Pielonefritis CMV
Estreptococoβ hemolí­tico
Sospecha de malformación fetal

Riesgo muy alto (III)
Amenaza de parto prematuro
Cardiopatí­as III y IV
Diabetes pregestacional
Drogadicción y alcoholismo
Malformación fetal confirmada
Gestación múltiple
Muerte fetal confirmada
Muerte perinatal recurrente
Incompetencia cervical
Retraso del crecimiento intrautero
Patologí­a asociada grave
Placenta previa
Preeclampsia grave
Rotura prematura de membranas en el pretérmino

Controles generales en gestaciones de alto riesgo

Primera visita

Anamnesis:

Filiación
Antecedentes familiares
Antecedentes personales
Antecedentes obstétricos y ginecológicos
Gestación actual
En cuanto a las analí­ticas y demás exploraciones complementarias iniciales serán básicamente las mismas que el control de un embarazo normal, de bajo riesgo. Fuera de esta lí­nea, pediremos aquellas pruebas que nos ayuden más al control de la patologí­a propia de cada paciente (electrocardiograma, ecocardiografí­a en patologí­a cardiaca, marcadores serológicas en infecciones virales…)

Visitas posteriores

La frecuencia de cada visita y las exploraciones complementarias vendrán determinadas por el tipo de enfermedad y por la severidad de la misma. Siempre habrá que controlar:

Peso, tensión arterial
Maniobras de Leopold (para buscar la presentación y el grado de encajamiento)
Cuantificación de FCF (frecuencia cardiaca fetal) y detección de DU(dinámica uterina)
Un hecho importante en el control del embarazo de alto riesgo obstétrico es mantener a la paciente informada de:

Pronóstico de su gestación
Influencia de la gestación en su enfermedad de base
Posibles complicaciones que pueden esperarse y su frecuencia aproximada
Posible prevención y/o tratamiento de las complicaciones
Frecuencia de visitas y de controles especiales que se prevé va a necesitar
Signos de alarma previsible por los que deberá acudir al hospital antes de las visitas programadas
La ví­a y momento de finalización del embarazo dependerá de cada paciente en caso concreto, teniendo siempre en cuenta la existencia de dos pacientes y la interdependencia entre los dos y procurando siempre el bienestar de ambos.

Dra. Irene Pérez de Avila Benavides
Especialista en Ginecologí­a y Obstetricia

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Un Comentario para “¿Qué es Embarazo de Alto Riesgo?”

  1. hola mi preguntas es ase 9 meses me isieron un degrado y asta ahorita no e podido embarazarme tengo una niña de 2 añitos de eya me isieron cesarea y me gustaria saver a que se deve eso el doctor me dijo que para septiembre podria embarazarme por que cuando se ase este tipo de cosas es un poco tardado me gustaria que me respondieran a este comentario saludos

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