Institute for Women's Health
High Risk Obstetrics
Lead: Alison Meldrum
Increasing numbers of women are becoming pregnant in spite of severe pre-existing illness such as repaired congenital heart disease or thalassaemia. Improved medical management of a range of conditions such as HIV infection, systemic lupus, sickle cell disease and blood clotting abnormalities mean that many more women with these conditions will consider pregnancy. Finally, there are complications that arise during pregnancy itself, such as preterm delivery, fetal growth restriction and pre-eclampsia that can have an adverse effect on the current pregnancy as well as increasing the risk of recurrence in subsequent pregnancies. Recent CEMACH reports into maternal deaths during pregnancy highlight the importance of multidisciplinary groups of health care professionals, with a focus on maternal and fetal well being, as being essential to achieve optimal outcome in these complicated pregnancies.For many years, care of these complex pregnancies has been undertaken at University College London Hospitals by a cohesive team of obstetricians, physicians and midwives. More recently, the group has expanded to include a consultant anaesthetist, cardiologist and haematologist. Antenatal care is provided in a single antenatal clinic which ensures close collaboration between doctors and midwives as well as providing a convenient “one stop” clinic where all aspects of antenatal care can be provided. In addition, close collaborations exist with the Primary Care Centre for joint management of drug using mothers as well as with the Mortimer Market center, who provide care for pregnant women with HIV. This unit is the tertiary referral centre for all such pregnancies in NE London , and accepts referrals from all over the UK, and sometimes internationally.
The same multidisciplinary make detailed plans for delivery, provide cover for inpatients with complicated pregnancies as well as running consultant provided elective caesarean lists where this is considered the most mode of delivery. Despite the often complex nature of these pregnancies the aim of management is to achieve safe vaginal delivery when appropriate.
The main aim is to optimize the outcome for mothers and their babies in pregnancies at increased risk of perinatal or maternal mortality/morbidity.
Page last modified on 11 dec 09 12:40