Pregnancy is usually a serene time in a women's life. However, sometimes it can be complicated by unexpected illnesses or medical conditions. When this happens, the pregnancy becomes high risk.

Fortunately, with the development of medical technology, pregnant women can be carefully monitored for signs and symptoms of high-risk pregnancies.

In the following fictionalized example, several real-life experiences are combined to explain how home devices, regulated by the Food and Drug Administration, can help monitor a high-risk pregnancy.

Gestational Diabetes

Sharon, 27 and expecting her first baby, was in her 18th week of pregnancy and feeling fine when her obstetrician told her that the routine blood screening test for glucose levels she had taken the week before identified her as a gestational diabetic.

If an expectant mother cannot metabolize (process) glucose (a form of sugar) properly, her fetus can receive too much glucose and grow too large. Glucose metabolism is altered during all pregnancies, but in women with gestational diabetes, erratic glucose metabolism is harmful to the fetus, causing problems during the pregnancy as well as during labor and delivery.

Because Sharon had always been healthy, she was shocked when her obstetrician told her that she was now considered a high-risk patient and would have to be closely monitored until her baby was born.

A team--including Sharon's obstetrician, the hospital's perinatal specialist, and a certified diabetic educator--began to work with her. They taught her how to monitor her glucose at home herself with a blood glucose monitor that she bought in her local pharmacy. Sharon was instructed in the principles of using the diabetic exchange diet. Although in Sharon's case diet alone was sufficient to control her condition, if it had not been, she would have been instructed how and when to inject insulin at home.

Infants of uncontrolled gestational diabetics often grow larger than full-term infants but are in other ways physically immature. The mother's placenta, the lifeline to the fetus, may not produce adequate nutrition for the infant to mature according to size. To monitor the growth and well-being of her fetus, Sharon was sent to the maternal-fetal radiologist for ultrasonic screening. Measurements of fetal movements and breathing patterns by the sonographer helped to ensure that the fetus was growing appropriately and appeared healthy.

During the last four weeks of her pregnancy, Sharon's perinatal team met weekly to discuss her case. They talked about the possibility of inducing labor if her fetus began to grow too large. Sharon had carefully followed her prescribed diet and had gained only 22 pounds. She had also monitored her blood glucose levels daily and adhered to a moderate exercise program throughout her pregnancy.

At 39 weeks gestation, one week before her expected delivery date, Sharon went into spontaneous labor. After a normal six-hour labor and vaginal delivery, she gave birth to a healthy 8-pound, 2-ounce son.

Like most women with gestational diabetes, Sharon's blood sugar levels returned to normal after she gave birth. On the third day after the birth, Sharon went home with her newborn son.

Almost all pregnant women are now screened for gestational diabetes during their second trimester, usually between 24 and 28 weeks gestation, because normal pregnancy causes a "diabetic-like" state in all pregnant women.

Some pregnant women can handle the imbalance of glucose and insulin while others cannot. When a pregnant woman develops diabetes during pregnancy, this medical condition is superimposed on the added stresses and physiologic changes that a normal pregnancy produces. Women with gestational diabetes must be carefully monitored for possible additional medical problems such as high blood pressure, vascular problems, and pre-term labor.

Pre-Term Labor

A woman who has a medical condition complicating pregnancy may be more likely to have an early labor and delivery. Smoking, poor nutritional habits, drug and alcohol abuse, and other poor health practices during pregnancy also increase the risk of early delivery and birth of stillborn or sick infants. Early in pregnancy, health professionals try to identify women who are at risk for pre-term labor and delivery so they can be monitored more frequently for early signs of the problem.

The usual length of a pregnancy is 38 to 40 weeks after the first day of the last menstrual period. Premature or pre-term labor is defined as labor occurring after 20 weeks and before 37 completed weeks of pregnancy. Although there is no firm data, estimates on the incidence of pre-term delivery suggest that 6 to 10 percent of all births in the United States occur between the 20th and the 37th week of pregnancy.

According to Robert K. Creasy, M.D., chairman of the department of obstetrics, gynecology, and reproductive sciences at the University of Texas Science Center at Houston, prematurity accounts for over 50 percent of the neurologically handicapped children in this country and is the greatest single cause of newborn illness and death.

Unfortunately, it is difficult to predict which women are at risk for pre-term labor. Since pre-term labor can occur in all age groups and within all social settings, researchers continue to explore what lifestyles and risk factors are common to women who experience pre-term labor.

Sometimes women mistake a certain type of contraction for labor. As early as six weeks into all pregnancies, the uterus, which is a large muscle, begins to contract rhythmically. These contractions called Braxton Hicks contractions) are usually irregular and painless, and, because they usually do not cause the cervix to dilate, they do not threaten the pregnancy.

Braxton Hicks contractions that tend to increase in frequency and intensity toward the end of the pregnancy may be misinterpreted as contractions of labor and are sometimes referred to as "false labor" contractions. Women are not usually aware of cervical dilatation, the stretching and opening of the entrance to the uterus, and cervical dilatation can only be measured by a health practitioner during a pelvic examination.

Trish Mooney of Takoma Park, Md., has had two high-risk pregnancies. During the first one, however, she didn't recognize the symptoms. Her son Isaiah was born after only 34 weeks' gestation, weighing 5 pounds, 8 ounces. During her second pregnancy, her contractions were recognized and, due also to her history of previous pre-term birth, she was put on bed rest. She also developed gestational diabetes. She was closely monitored and last May, after a full-term pregnancy, gave birth to her daughter Leslie, who weighed in at 8 pounds, 4 ounces.

What to Do

A pregnant woman experiencing contractions, either painful or painless, anytime during pregnancy, that occur more than four times an hour or are less than 15 minutes apart should report this activity to her physician or midwife, and be prepared to answer the following questions:

* When did the discomfort start?

* What is the type and frequency of the contractions?

* What were you doing when the symptoms began?

* Do you have any other signs or symptoms such as:

* menstrual-like cramps that may come and go

* abdominal cramps with or without diarrhea

* backache that is dull and may radiate around toward the abdomen

* Vaginal discharge increase or a noticeable change in color

* pelvic pressure that is constant or intermittent.

While waiting for her provider to return her call, the woman should:

* lie down with her feet elevated

* drink two or three glasses of water or juice.

These two activities sometimes cause contractions to subside. If symptoms do not lessen within one hour and the woman is not able to get in touch with her health-care provider, she should go to the nearest hospital for further evaluation.

Home Monitoring

Home monitoring of the mother-to-be who has signs of pre-term labor may be ordered by her health-care provider, especially if she must be on bed rest for a significant time (often 20 weeks or more). Home care, although quite expensive itself, may help reduce costs and continue to provide a safe and satisfactory means of monitoring the pregnancy. Some insurance companies cover the cost of home care visits and some aspects of home monitoring equipment. Not all insurance companies cover home uterine activity monitoring.

In the fall of 1990, FDA approved for marketing the Genesis Home Uterine Activity Monitoring System to monitor uterine activity in women past their 24th week of pregnancy who have histories of previous pre-term births. The purpose of such monitoring is the early detection of uterine activity, which can cause cervical dilatation and pre-term labor.