Most pregnancies progress without any complications. However, sometimes a mother or her unborn baby needs extra care from our highly experienced Fetal Medicine team - made up of specialists including fetal medicine consultants, midwives and healthcare assistants.
As a specialist unit within Liverpool Women’s, we receive many referrals from health professionals throughout the North West and further afield.
Women are referred to the Fetal Medicine unit at the beginning of their pregnancy, if they have a complex history, or if any fetal abnormalities are identified at ultra sound scan.
In the fetal medicine unit we also see women who have had certain placental issues identified.
In line with the National Fetal Anomaly Screening Programme (FASP), we aim to see women with recognised FASP conditions within 3 to 5 working days. Any referrals that sit outside of this programme are triaged by our team of specialist midwives and consultants and will be seen as soon as is clinically appropriate. This is usually within 3 to 10 working days.
Extra care for high risk pregnancies
The work undertaken by the team primarily focuses on the management of high risk pregnancies and specialist screening. They work closely with our clinical genetics team to ensure patients receive complete continuity of care. Patients are referred to us for many reasons - typically if they are having a multiple pregnancy (twins or triplets), require an invasive procedure, such as amniocentesis, or have a previous or current fetal abnormality diagnosed during pregnancy.
Fundraising
Help the team to reach their fundraising target to allow them to care for more women, by redesigning the unit to match the excellent standard of care they provide - call 0151 702 4044, visit the Liverpool Women's Charities Facebook page or learn more about how you can support us.
Contact
Fetal Medicine Unit 2nd Floor Liverpool Women’s Hospital
- On call Consultant Obstetrician: Switchboard: 0151 708 9988 ask for Obstetric Consultant on call Bleep 100
Liverpool Women’s Hospital is one of three Maternal Medicine Centres (MMC) within the North West Maternal Medicine Network along with St Mary’s Hospital Saint Mary’s Hospital (Manchester University NHS Foundation Trust) and Royal Preston Hospital (Lancashire Teaching Hospitals NHS Foundation Trust).
Liverpool Women’s vision as a MMC is to facilitate safer outcomes and better birth experiences for mothers and babies with medical conditions. The Maternal Medicine Centres will provide a regional service including pre-pregnancy, antenatal and postnatal care for women who have either pre-existing significant medical problems or medical problems arising in or shortly after pregnancy. The MMCs will also provide advice and care for the most complex and highest risk women including those with respiratory, haematological, renal and cardiac problems and women diagnosed with cancer.
The majority of women with complications during pregnancy will continue to be managed by their local maternity team, however according to individual need, some women may receive a proportion of their care under the MMC. For some, a single visit or communication with the MMC will suffice. For the highest risk and most complex women, it may be that the majority of their care will be delivered by the MMC.
This model of care ensures that investigations and management plans are carried out by an experienced Multi-Disciplinary Team (MDT) comprising of obstetric physicians, specialist physicians, obstetricians, anaesthetists and midwives who have expertise in a range of medical conditions, ensuring all women receive timely specialist care and advice before, during, and after their pregnancy.
The MMC will host a specialist MDT meeting, which will provide advice and care for high risk and complex women, along with system-wide leadership and education. The MDT will include obstetricians and physicians from the MMC and from across the region, a specialist obstetric anaesthetist, a fetal maternal medicine consultant, a neonatologist and specialist midwives.
The referral link below should be used by physicians (General Practitioners and Specialist Doctors) and Obstetricians within Cheshire and Merseyside to refer patients into the MMC:
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For some women an appointment (either face to face or virtually) will be arranged at one of the joint specialist clinics. The Woman will be contacted by the LWH maternal medicine team and informed of their appointment. For others, the woman’s case will be discussed at the MMC MDT, which will also be attended by their local parent team. For the highest risk and most complex women, it may be that all care will be recommended to be delivered within the MMC. In these instances, following MDT discussion, the patient will be contacted, and a booking appointment and specialist clinic appointment will be arranged at LWH.
Contact
Maternal Medicine Unit
0151 708 9988 Ext 4271 Mon-Fri 8:00 – 6:00Pregnancy and the Postnatal period can be an unpredictable time for you and your family. 1 in 5 women with experience a mental health concern during this time. Pregnant women who have mental health concerns can gain support from our Perinatal Mental Health Team. Our Liverpool Women’s Team is run by two Perinatal Mental Health Midwives and a link consultant Obstetrician. Midwife clinics are run daily at Liverpool Women’s Hospital Monday – Friday, with a joint Consultant / Midwife clinic on a Tuesday. Our midwives work closely with other mental health services to ensure mental health and obstetric care runs smoothly together. If you require support with your mental health in pregnancy, please speak to your midwife who can generate a referral to the team
If you require URGENT support with your mental health please call 111 and select option 2. This a 24/7 helpline service to support you with your urgent mental health concerns.
Mental Health Medication in Pregnancy:
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Perinatal Mental Health Services:
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Useful links for partner support:
NHS Talking Therapies (Links listed above)
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About the clinic
This is a specialist clinic dedicated to preventing preterm birth. This centre carries out research into ways to predict and prevent preterm birth. Through our clinic we work with women at high risk of preterm birth to give them the best possible chance of a healthy pregnancy.
Who should attend?
We normally see women between 16 and 26 weeks of pregnancy in line with the referral criteria set out in the national saving babies lives care bundle V3. We see those who have the following risk factors for preterm birth:
- Previous spontaneous birth or rupture of membranes under 34 weeks of pregnancy
- Previous or current cervical cerclage
- Those with a uterine anomaly
- Asherman's syndrome
- Those with a history of trachelectomy
We also see those with previous treatments performed in the hospital for some women after a smear test:
- Previous knife cone biopsy of cervix
- Two or more previous LLETZ or loop excisions of the cervix
- Single loop excision with a depth of 15mm.
- Those who have undergone a previous caesarean section birth at full dilatation.
Some women may require preterm birth prevention treatment earlier in pregnancy than 16 weeks, and in these cases, we see women from about 12-14 weeks of pregnancy.
We also see other small groups of women who are identified on an individual basis - if you think you should be seen in pregnancy please discuss with your midwife or obstetrician and we will be happy to discuss cases.
What happens in the clinic?
The clinic takes place every Thursday afternoon between 1.30pm and 4.30pm,
A detailed history is taken about the woman’s health, pregnancies and risks for preterm birth. Most women then have an internal (vaginal) scan to assess the cervix (‘neck of the womb’). An individualised plan is then made with the woman about her risk of preterm birth, need for further screening, and need for preterm birth prevention treatments.
Who is available in the clinic?
Women are cared for by a doctor with an interest in preterm birth, a specialist preterm birth midwife, and supported by a team of midwives and health care assistants.
Tel: 0151 702 4072
Monday- Friday 8.30-1630
Pregnant women who have mental health concerns can gain support from our Perinatal Mental Health Team. Our Liverpool Women’s Team is run by two perinatal Mental Health Midwives and a link consultant Obstetrician. Midwife clinics are run daily at Liverpool Women’s Hospital Monday – Friday, with a joint Consultant / Midwife clinic on a Tuesday. Our midwives work closely with other mental health services to ensure mental health and obstetric care runs smoothly together. If you require support with your mental health in pregnancy, please speak to your midwife who can generate a referral to the team.
Most babies aren’t harmed if you get an infection during pregnancy but some bugs can have serious consequences, such as toxoplasmosis which is caused by an organism in cats’ faeces. Also our consultants, obstetricians and midwives endorse the guidance by the Chief Medical Officers, NHS Choices and the Royal College of Obstetricians and Gynaecologists that all pregnant women should be offered the Swine Flu vaccine together with the seasonal flu vaccine and we encourage women in our care to make the necessary arrangements with their GP.
Most women gain between 10kg and 12.5kg (22-28lb) while pregnant but much of that extra weight is due to the baby growing, or natural changes in the body. Try and keep active and limit your intake of fatty foods and sugar-laden snacks and, if you are concerned, talk to your midwife or GP.
Rather than just using weight to assess who is at risk, we use BMI (Body Mass Index), which takes into account people’s weight and height. It is a nationally recommended way of assessing health issues associated with weight. Internationally, a figure of 19-25 is classified as normal, 25-30 is overweight, 30-40 is obese and over 40 is very obese.
Pregnant women with a BMI of 30 or more are more likely to have:
Diabetes in pregnancy High blood pressure problems Difficulties with assessing the growth and well being of the baby Caesarean sections Complications associated with caesareans or forceps deliveries A higher risk of developing clots in the legs or lungs Anaesthetic complications Antenatal care: Women with a BMI of 35 or over will be referred for consultant-led care and will be offered a glucose tolerance test (GTT) around 28 weeks of pregnancy to assess their body’s ability to handle sugars and detect any tendency towards diabetes during pregnancy. Women with a BMI of 40 or more will also be referred to specialist consultant- led care . Ideally women with a BMI of 30 or more should have taken folic acid 5mg up until 12 weeks. Some women may also be prescribed a vitamin D supplement and aspirin during pregnancy.
Scans: Scanning the unborn baby of a woman with a high BMI is technically more difficult as much of the power of the ultrasound waves is absorbed by the mother’s tissues. Therefore the images obtained may not be as accurate as those normally obtained. This may mean a reduced ability to detect problems, for instance at the 20 week anomaly scan. Further scans for growth may be arranged by the consultant or midwife, if they are concerned about the growth of the baby as pregnancy progresses. A scan may also be performed at 36 weeks of pregnancy to confirm which way the baby is lying and make a plan for the birth.
Labour and birth: If you have a BMI between 30 and 39 and have been fit and well during your pregnancy, you will be offered to give birth in the midwife-led unit, where normal birth is encouraged. You will also have the choice of a water birth if you wish. If your BMI is greater than 40 you will be advised to give birth in the delivery suite.
Pain relief in labour: There are a number of options available to you for pain relief during labour. These include entonox (‘gas and air’), water (if you are on the midwife-led unit), diamorphine and an epidural. Being obese can mean there is an increased risk of complications if you have an anaesthetic during labour and birth (epidural or spinal). Therefore, if your BMI is 40 or more, an appointment will be made for you to see an anaesthetist during your pregnancy, who will discuss this with you and make a plan for when you are in labour, should you wish to have an epidural.
Postnatal care: If you have a caesarean section to give birth to your baby, recovery following the operation may be slower if your BMI is 30 or more. You will be given antibiotics when you are in theatre to help prevent any infections. You are also encouraged to mobilise out of bed as soon as possible to help reduce the risk of blood clots developing in your legs or lungs and you may also need to have a daily injection to ‘thin’ your blood to help prevent this. These injections will be for seven days after you have had your baby.
Every cigarette a pregnant woman smokes harms her baby. Cigarettes contain over 7,000 chemicals and restrict the essential oxygen supply to the baby, forcing its heart to beat harder each time you smoke.
Babies of mothers who smoke are, on average, 200g (about 8oz) lighter than other babies. They may have problems during and after labour and are more prone to infection and at a higher risk of cot death. The good news is that by quitting, the benefits to you and your baby begin almost immediately, with carbon monoxide and chemicals clearing from the body and oxygen levels returning to normal.
Pregnant women who are smoking in pregnancy can gain support from our Specialist Maternity Treating Tobacco Dependency Team. Clinics are run daily at Liverpool Women's Hospital Monday-Friday. If you require support, please contact your midwife who can generate a referral to the team or you can contact the team number on 07815652919.
Alternatively, take advantage of the free NHS support that is available, as you are four times more likely to quit successfully this way.
Call the NHS Pregnancy Smokefree Helpline on 0800 169 9169.
Help is also available for family members and partners who would like to quit smoking:
Call: 0151 374 2535
Text: QUIT1 to 61825
Email: smokefreeliverpool.co.uk
When you drink, alcohol reaches your baby through the placenta. Too much exposure to alcohol can seriously affect your baby’s development.
Drinking is not just dangerous for the baby in the first three months – alcohol can affect your baby throughout pregnancy. A particular group of problems known as Fetal Alcohol Syndrome (FAS) can affect babies of women who have drunk heavily through pregnancy. These include restricted growth, facial abnormalities and learning and behavioural disorders. You can get help from our team of enhanced midwives by seeking a referral through your GP. Confidential help and support is also available by contacting Drinkline on 0800 917 8282.
Illegal drugs such as cannabis, ecstasy, cocaine and heroin can also harm your baby. It’s important to talk to your doctor or midwife so they can provide support and advice to help you stop. Some dependent drug users initially need drug treatment to stabilise or come off drugs to keep the baby safe. You can get help from our team of enhanced midwives by seeking a referral through your GP from any of the midwives in the Antenatal Clinic at the hospital or through your community midwife
Domestic abuse during pregnancy increases the risk of miscarriage, infection, premature birth, low birth rate, fetal injury and fetal death. If you are pregnant and are being abused - whether physically, sexually, emotionally or psychologically - there is help available. You can get help from our team of enhanced midwives by seeking a referral through your GP from any of the midwives in the antenatal clinic at the hospital or through your community midwife.
National Domestic Violence Helpline on 0808 2000 247.
At Liverpool Women’s, we have a team of enhanced midwives that give extra support to vulnerable pregnant women and their families. The team is trained in dealing with women and families who have complex and often multiple needs around substance misuse, mental health, domestic abuse and other issues. You can get help from our team of enhanced midwives by seeking a referral through your GP from any of the midwives in the Antenatal Clinic at the hospital or through your community midwife.
More information
North West Maternal Medicine Network.