High-Risk Obstetric Service

Existing Health Conditions

• High blood pressure
• Polycystic ovary syndrome (PCOS)
• Diabetes
• Kidney disease
• Autoimmune disease
• Thyroid disease
• Obesity
• Certain infections e.g. Zika

Life Decisions & Lifestyle

• First pregnancy after age 35
• Alcohol use
• Tobacco use
• Drug use

Conditions of Pregnancy

• Multiple gestation
• Gestational diabetes
• Pre-eclampsia and eclampsia
• Previous preterm birth

First Pregnancy after age 35

With busy lives and careers, this is perhaps one of the more common reasons for a pregnancy to be higher risk. Most pregnancies to older first-time mothers are normal but there are heightened risks of the following:

• Pregnancy-related high blood pressure (called gestational hypertension)
• Diabetes (called gestational diabetes)
• Pregnancy loss
• Ectopic pregnancy (when the embryo attaches itself outside the uterus)
• Caesarean delivery
• Delivery complications, such as excessive bleeding
• Prolonged labour (lasting more than 20 hours), or labour that does not advance
• Genetic disorders in the baby e.g. Downs Syndrome

Consequently, these are pregnancies and deliveries where we want to adopt a heightened vigilance and ensure there are plans in place to manage any specific risks.

Gestational Diabetes

Gestational diabetes is diabetes that is diagnosed for the first time during pregnancy. The good news is that it normally reverts after pregnancy. However, it can lead to sometimes serious complications during pregnancy and delivery and as such needs careful management and birth planning, with heightened coordination between obstetrician and neonatologist. Some of the complications include:

• Excessive birth weight, requiring a caesarean section delivery
• Early (preterm) birth, requiring baby to be admitted to NICU under a neonatologist
• Serious breathing difficulties, requiring immediate attention from a neonatologist
• Low blood sugar (hypoglycemia), sometimes requiring specific support for your baby
• Obesity and type 2 diabetes later in life, for mum
• Stillbirth, an occasional complication of poorly managed gestational diabetes

Gestational diabetes is very common in Cayman Islands, especially in mums of Caribbean origin. At Integra, we will always monitor closely for it so that we can ensure it is managed well during pregnancy and plan birthing arrangements to ensure everything goes smoothly and safely.

Fetal Medicine

Our fetal medicine service is designed to ensure that fetal and maternal health are optimally managed through pregnancy, especially where risks or concerns exist. It’s planned from pregnancy to pregnancy and involves pre-conception counselling for women with previous adverse pregnancy outcomes, care of women with fetal abnormalities and fetuses identified with growth restriction, monitoring of fetuses during pregnancy and liaising with neonatal team to plan and ensure appropriate timing and place of delivery.Dr Madhavi Manoharan has advanced training in fetal medicine, accredited by the Royal College of Obstetricians and Gynaecologists in UK and more than a decade of consultant-level, tertiary experience.

Pregnancy Imaging

With the importance of scanning in identifying anomalies and concerns, we take a very comprehensive approach in order to successfully guide our care through pregnancy, birth and beyond. This means state of the art, 3D and 4D scanning by a specialist radiographer, which is then reported by specialist radiology and our own fetal medicine specialist, Dr Madhavi Manoharan. Concerns are then evaluated by our full team and care planned accordingly, all in full discussion with you.Our equipment is some of the very best available and we have multiple 3D/4D ultrasound machines in-house.