Service Evaluation of Combined Rheumatology/ Obstetric Clinic at a tertiary care hospital, England
Dr. Rabia Gul, Dr. Fahd Ali Khan, Dr. See Chin Mun, Dr. Emily Steele, Dr. Tsehieng Kong, Miss Malini Shivanath, Dr. Geetha Janakiraman
James Cook University Hospital, South Tees, NHS Trust, Middlesbrough, United Kingdom
Introduction:
Inflammatory rheumatic diseases (IRDs) are believed to improve during pregnancy but half of the patients end up having postpartum flares. Better control of IRDs prior to, during, and post-pregnancy, improves maternal and fetal mortality/ morbidity minimizing both maternal and fetal complications. DMARDs compatible with pregnancy are required to control disease activity to ensure positive pregnancy outcomes. A multidisciplinary approach with dedicated combined clinics and with respective field experts who can cater to this population is associated with better outcomes. EULAR has set recommendations around pre-pregnancy, during pregnancy and post-pregnancy care for females with IRDs.
Aims/Objectives:
•To evaluate the Service of the Combined Rheumatology Obstetrics clinic held at a tertiary care hospital in England for pregnant patients with IRD against the EULAR recommendations.
•To observe the patient and disease outcome in terms of maternal and fetal health.
•Assess patient satisfaction in the combined clinic.
Methods:
•Retrospective study of the 40 patients who attended the combined Rheumatology/ Obstetric Clinic from November 2020 to February 2022.
•Data collected from clinic letters, medical notes, and maternity database
•Patient satisfaction questionnaire was posted to capture patient satisfaction with a 33% return rate.
Results:
Case mix:
•77% of the patients had Inflammatory arthritis.
•15% had connective tissue disorder(CTD)
•2 % did not have any formal IRD diagnosis and were excluded from further analysis.
•12.5% received dedicated pre-pregnancy counselling
• 2.5% had miscarriages
•10% of the remaining 85 % of patients had obstetric care in other hospitals.
IRD treatments during pregnancy:
•29% received oral DMARDs
•11% received biologics
•16% needed steroids
•Half of the patients did not require any treatment.
Interventions in the clinic:
•all the patients had medication reviewed and VTE assessments.
•7.5% required VTE prophylaxis
•10% needed either change medications or needed dose adjustment
• 10 % needed physiotherapy.
Pregnancy outcomes:
•The pregnancy outcomes in IRD patients were similar to general population
•93.3% had full-term deliveries
•5% had pre-eclampsia, 0.07% had gestational diabetes and 0.02% had pregnancy-induced hypertension and fetal growth restriction.
Neonatal outcomes: none had congenital heart block, 10% had neonatal adverse outcomes including preterm births and 3.3% had congenital heart malformation unrelated to the IRA treatment.
Patient survey:
•100% satisfaction with staff.
•100% patient awareness of the impact of 1RD and the medications on the pregnancy.
•66.7% received pre-pregnancy counseling.
•50% received in combined obstetrics/rheumatology clinics.
•Aspects of care discussed in the clinic are shown in the graph.
Conclusion:
•Our service evaluation of the pregnant patients with IRD showed no major adverse outcome for the mother and the baby and had a high patient satisfaction rate.
•The combined rheumatology/Obstetric clinic offered timely and appropriate interventions and reassurance to patients which led to good pregnancy outcomes.
Future plans
•To aim for increased pre-pregnancy counselling for patients than 12.5% at present.
•Maintain a robust database to assess pregnancy outcome trajectories
•Update the clinic proforma to align with EULAR data collection recommendations.
•Develop referral proforma for IRD patient referral to the combined clinic.
•To continue to provide excellent care to all pregnant patients with IRD expanding this to all of the Teesside regions.
