NHS England (NHSE) has announced that 17 new "centres of excellence" will be established across the country to provide specialist care to pregnant women with serious medical conditions, either pre-existing or arising during pregnancy.
The new centres are part of the NHS commitment to halve the maternal mortality rate as well as that of stillbirths, neonatal mortality and serious brain injury by 2025. There will be at least one centre in every region of the country, including at Guy's & St Thomas' and St George's Hospitals in London, Oxford University Hospitals, and centres in Liverpool, Manchester, and Newcastle.
England's Chief Midwifery Officer Professor Jacqueline Dunkley-Bent said: "The establishment of these maternal medical networks will improve every woman's access to specialist care for medical problems in pregnancy and will play an important part in our wider efforts to improve care for women and babies right across our maternity services."
NHSE said that 1 in 5 women have a medical issue during pregnancy, and while most conditions, such as well-managed diabetes, can be safely treated locally, the most serious cases will be treated at these 17 centres, where women can be closely monitored and provided with specialist attention throughout their pregnancy.
Linked Networks to Optimise Specialist Care
Some women may be sent for an initial assessment at one of the centres, where they will be set up with a personalised management plan that they can continue at home, with support from their local maternity team.
The centres will be organised as a concatenation of networks to ensure that access to expert maternal medicine care is available to all women and that women who need specialist care receive medications and procedures that are safe in pregnancy, from an expert team which can advise on how to optimise those treatments.
The new maternal medicine networks will work with local GPs, emergency departments, and community midwifery services to ensure all pregnant women can access these services when needed.
More Specialist Obstetric Physicians Promised
Key to the new hubs will be the role of obstetric physicians, a relatively new higher specialty physician trainee credential in obstetric medicine introduced by the Royal College of Physicians (RCP) in November 2020. An alternative route to the qualification is a post-certificate of completion of training (CCT) credential in obstetric medicine open to those with a CCT in a medical specialty who are already in substantive consultant posts, specialist registrars who have a CCT or CESR or equivalent, and SAS doctors where appropriate.
Obstetric medicine is also part of the Royal College of Obstetricians and Gynecologists (RCOG) core curriculum and a recognised advanced training skills module that can be undertaken during the last 2 years of specialty O&G training.
Previously, there were fewer than 10 obstetric physicians in the country, but the NHS has given a commitment to have obstetric physicians in place in every maternal medicine centre. Following the independent review of maternity services at the scandal-hit Shrewsbury and Telford Hospital NHS Trust by Donna Ockenden, published in March last year, it had promised to establish a sustainable training pathway for them with the RCP and Health Education England. Already, NHSE said, it had funded the training of a further 6 consultants, with 3 more due to start by the end of next year.
Supporting Pregnant Women With Complex Needs
Lucy MacKillop, consultant obstetric physician at Oxford University Hospitals, explained: "We support people with complex medical needs before, during, and after their pregnancy, and our aim is to give them and their babies the best care and safest experience possible."
In her capacity as president of the MacDonald Obstetric Medicine Society, she welcomed the recognition of "the vital role obstetric physicians can play in these networks".
The NHS said that each specialist hub will include at least one obstetric physician alongside a dedicated multidisciplinary team, "bringing together expert physicians, obstetricians, midwives, nurses, and other clinicians in one place".
Promoting Awareness of 'Red Flag' Symptoms
This means that pregnant women with serious medical problems will have access to specialist treatment centres to access the extra care they might need. The centres will also ensure that all maternity services and emergency departments are aware of key 'red flag' symptoms in pregnancy and have measures in place so that pregnant women can be appropriately assessed by a specialist physician or obstetrician.
Although maternal mortality in England is rare, the majority of maternal deaths are caused by medical conditions that pre-date or develop during pregnancy – such as cardiac disease (23%), blood clots (15%), and epilepsy and stroke (13%) – that can be missed or misattributed to pregnancy.
Professor Dunkley-Bent said: "We know that pre-existing medical problems are a significant factor in the variation in rates of mortality for Black and Asian women."
Serious Medical Problems Often Missed in Pregnancy
Dr Matthew Jolly, national clinical director for maternity and women's health, said: "For a number of years, too often we have seen symptoms of serious medical problems being missed or misattributed to pregnancy.
"Maternal medical networks and their specialist centres are a vital step in improving the identification and management of potentially fatal medical conditions in pregnancy, wherever a woman receives care."
Dr MacKillop, who contributed to the RCP curriculum for the credential in obstetric medicine and is an external assessor for the programme, said: "It is vital that we support everyone with significant medical conditions that pre-date or arise in pregnancy so they have equal access to timely specialist care and advice."
Asked to comment by Medscape News UK, Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said: "This is a welcome step to improve care and support for women with pre-existing medical conditions during pregnancy. Establishing these services will improve access to specialist care when needed, ensuring women receive the right care at the right time.
"It's positive to see the commitment to train more obstetric physicians to be involved in each specialist hub. The Government needs to commit to a fully funded, long-term workforce plan to ensure there are adequate staffing levels throughout obstetrics and gynaecology services."
