High-Risk Obstetric Service

Integra Healthcare Ltd has a special interest in high-risk pregnancies. There are many factors that can make a pregnancy high risk, including existing health conditions, your age, lifestyle, and health issues, including those that that happen before pregnancy but also some that happen during pregnancy.

Whereas the majority of high-risk pregnancies and births go without complication, in part that is because of the careful approaches and protocols adopted to ensure that the risk factors are appropriately addressed. It also means ensuring that you have just the right backup ready to be engaged if needed.

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Highly experienced, tertiary consultant, multidisciplinary team

All key staff live within 5 minutes of hospital

24/7 access for concerns or urgent care issues

What is a high-risk pregnancy?

Quite simply, it is any pregnancy where there is a greater than normal chance of complications for either Mum or the baby. There are many factors that can predispose a pregnancy to risk. The following is not designed to be fully comprehensive but certainly covers the main ones.

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
  • Preeclampsia 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.

Integra Healthcare’s High-Risk Pregnancy Service

The Integra Obstetric-Neonatal team collectively represents decades of consultant-level, tertiary experience in managing both high risk pregnancies and the fetal or newborn complications that can arise. It is quite simple unique on Island:

  • Only combined Obstetric-Neonatal team, allowing a true, seamless, multidisciplinary approach
  • Only team with both obstetric and neonatal accredited and experienced tertiary consultants
  • Detailed fetal anomaly scans conducted by a highly experience sonographer and independently reported
  • All key obstetric and neonatal team members live within 5 minutes of Cayman Islands Hospital in George Town
  • 24/7 access to the team for concerns or urgent care issues

Based on our combined experience of literally thousands of high-risk pregnancies, here and in the UK, our approach is comprehensive, designed to assess all risk factors, proactive and multidisciplinary. We’d be delighted to talk through that approach in detail, without charge, so that you can understand just why it is unique, as well as meet the team members who might be involved.

Meet the High-Risk Pregnancy Team

If you are in any way concerned you may fall into a high-risk category, or have a family history of higher risk pregnancies or complications, we’d be delighted to meet you, completely without charge, either before conceiving or at any stage, so that we can discuss this with you and so that you are familiar with the team.


Dr Lisa Joels

Obstetrician & Gynaecologist
Tel: +1 (345) 745 7450 (clinic)
Mob: +1 (345) 526 8965
Email: lisa.joels@integra.ky

Dr Lisa Joels, is a highly experienced Obstetrician with over 34 years of experience, 19 of which at the level of consultant working in tertiary University hospitals caring for complex or high-risk pregnancies. Qualified in MOET (Managing Obstetric Emergencies & Trauma),  she’ll support you throughout your pregnancy to ensure everything goes well and if nature throws in a hurdle, she has decades of experience to draw upon.


Dr Madhavi Manoharan

Obstetrician & Gynaecologist
Tel: +1 (345) 745 7450 (clinic)
Email: madhavi.manoharan@integra.ky

Dr Manoharan has 23 years’ experience in obstetrics and gynaecology, including more than a decade at tertiary level, 7 years as consultant at the prestigious Royal Free London NHS Foundation Trust and a number of years as Assistant Professor at the world-renowned Weil Cornell Medicine, located in their Qatar campus, part of Cornell University.

Dr Sara Watkin

Specialist Paediatrician & Neonatologist
MB ChB, MRCP (paeds), FRCPCH, MD
Tel: +1 (345) 745 7450 (clinic)
Mob: +1 (345) 326 7827
Email: sara.watkin@integra.ky

Prior to moving to Grand Cayman, Sara was Chief of Service for the prestigious and renowned neonatal service at University College Hospitals London, caring for a complex mix newborn patients from the extremely preterm to those with complex genetic abnormalities. On Island, she has supported the very smallest patients and many of the most complex, including saving many lives in difficult circumstances.

Get in touch…

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Team is Important

A successful outcome in a higher-risk pregnancy is a function of the right skills, expertise and experience when you need them most, focused on both Mum and Baby, with seamless communication and coordination between care professionals. Having that whole team in Integra means a true multidisciplinary approach to managing even the most difficult of pregnancies. Dr Joels and Dr Watkin,  collectively, more than 60 years experience in caring for Mum & Baby, earned in tertiary centres in the UK. That’s a unique combination devoted to your successful pregnancy.

News, Views & Pertinent Pieces


Dr Lisa Joels

Obstetrician & Gynaecologist
Tel: +1 (345) 745 7450 (clinic)
Email: lisa.joels@integra.ky

Dr Joels has 34 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20).


  • Gynaecological Services
  • Paediatric and Adolescent Gynaecology
  • Obstetric Services
  • High-Risk Obstetric Service
  • Fertility Services

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Clinic Location & Open Times

The Grand Pavilion Commercial Centre, Hibiscus Way, 802 West Bay Road.

  • Monday to Friday: 8.30am first appointment, 4.30pm last appointment
  • Saturday: 8.30am first appointment, 12.30pm last appointment
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