Maternal medicine

People who have cardiac disease who are pregnant or considering pregnancy will be invited to attend our specialist obstetric cardiac clinic.

This clinic is supported by a multi-disciplinary team meeting (including cardiologists, obstetricians, anaesthetists, and when necessary haematologists and neonatologists) where patients with heart disease are discussed to ensure optimal care.

Clinics are held at City Hospital on Tuesday afternoons. The clinic team is led by Dr Gemma Malin and Dr Suzanne Wallace, Consultant Obstetricians.

Care is individualised both during pregnancy and birth, taking into consideration pregnancy and cardiac factors, and your preferences. In most cases a vaginal birth is recommended. There are very few heart conditions in which caesarean birth is considered safer.

Specialist clinics focusing on diabetes in pregnancy (Type 1, Type 2 or gestational diabetes) are held at both Nottingham City Hospital and QMC. To ensure the best possible care, people who are pregnant are seen regularly throughout their pregnancy and given advice and guidance to minimise the risks for both them and baby.

The multi-disciplinary team includes consultant obstetricians, endocrinologists, diabetes specialist nurses and midwives and dieticians.

For further information on planning a pregnancy when you have diabetes see the Diabetes UK website.

The service submits data on the care of pregnant people with Type 1 or Type 2 Diabetes to the National Pregnancy in Diabetes audit to compare the outcomes of these service users in our clinic to those across the country.

We offer specialist clinics at both City Hospital and the QMC, for people who are pregnant and who have epilepsy. These enable people who are pregnant or considering pregnancy to have care from an epilepsy specialist nurse and obstetrician with support from a consultant neurologist.

The QMC Clinic takes place on Tuesday mornings and the City Hospital Clinic takes place on Thursday afternoons.

People with other seizure disorders (including non-epileptic attack disorder) are also seen within these clinics.

Before your appointment: 

• take high dose (5mg) folic acid daily, ideally starting before you become pregnant (this needs to be prescribed by a doctor)

• do not stop your anti-epileptic medication.

For more information please see the NHS website: Epilepsy and pregnancy.

Our service is run jointly by consultant obstetricians and endocrinologists at each campus. We see pepole who have thyroid disease and other endocrine problems including Addison's disease. 

 

Hypothyroid

If you have an underactive thyroid (which has never been overactive), ask your GP to check your thyroid function when you find out you are pregnant. You may need an increase in the dose of your thyroxine medication during pregnancy to optimise your levels.

If necessary, your GP can refer you to one of our clinics.

 

Hyperthyroid

If you have, or have previously had, an overactive thyroid, you will be offered an appointment at one of our clinics. If you are on treatment to control your thyroid, please discuss with your endocrine consultant if you are planning a pregnancy for advice.

If you discover you are pregnant, please inform your GP or consultant as soon as possible and ask for an early referral to our service. 

We offer haematology clinics at both City Hospital and QMC. 

There are a variety of people who are suitable for this clinic, for example:

• people with sickling disorders or thalassaemia
• people who have been affected by lymphoma or leukaemia
• people who have low or high platelets
• people who have had a thrombosis.

There are many other conditions where women affected would benefit from the clinic, and these will be assessed individually at your first appointment with your midwife.

You may be referred to this service if:

You have pre-existing high blood pressure and become pregnant

• If you are planning a pregnancy, or find out that you are pregnant, speak to the GP or hospital consultant who  prescribes the medication you take to control your blood pressure as soon as possible. They will ensure that you are on a medicine that is safe for pregnancy.

• We recommend that you take aspirin 75mg once a day from 12 weeks of pregnancy to reduce the risk of developing pre-eclampsia. Your midwife or GP should arrange a prescription.

You have developed hypertension in pregnancy

• It may be necessary to arrange further tests or follow up to determine the cause of the high blood pressure

• Having high blood pressure in pregnancy, particularly pre-eclampsia that begins before 34 weeks, means that you have a higher chance of developing high blood pressure in later life. We will advise you on further investigations, and lifestyle advice, to help you reduce the risk.

The maternal clinic is held on Tuesday morning at QMC and the City Hospital clinic is held on a Thursday afternoon.

People with kidney disease who are pregnant or considering pregnancy should be invited to attend our specialist obstetric renal clinic.

This clinic is at City Hospital on Thursday afternoon and enables people to seek advice from a renal physician and specialist obstetrician at the same time. 

See our leaflet for more information