The antenatal metabolic clinic
Women who are severely obese (have a BMI of over 40) can be referred to the metabolic clinic by their GP, midwife or obstetrician, referrals can only be accepted from the Lothian region.
The metabolic antenatal clinic is home to specialists in pregnancy care and diabetes, as well as midwives and a specialist dietician. Care offered to women includes frequent check-ups of mothers and babies, as well as personalised advice about health eating. The clinic uses specialist equipment such as Tanita scales, that allow clinicians to measure women's weight and body composition at each visit. We also use 'thigh' cuffs to accurately measure blood pressure, and have access to extra-large support stockings for thromboprophylaxis.
We have developed a special care pathway for helping obese women to have healthy pregnancies:
At the first clinic visit all women are reviewed by the dietician and given personalised healthy eating dietary advice and advice to maintain their weight during pregnancy. We explain to women that they have a high risk pregnancy and reassure them that they will be monitored closely during their pregnancy. We recommend that women attending have early screening for gestational diabetes following the Scottish Intercollegiate Guidelines Network (SIGN) guidelines with a fasting glucose test at less than 20 weeks' gestation, and a 75g oral glucose tolerance test at 28 weeks' gestation.
For uncomplicated pregnancies, women are usually reviewed at the clinic 4 times. At these visits, women will have fetal growth scans and meet with the interdisciplinary team. Women with extra risk factors such as gestational diabetes are seen as often as every one to two weeks.
Women attending the clinic will continue to see their community midwife to provide continuity of care during and after pregnancy.
|Weeks into pregnancy
||Initial visit, personalised pregnancy plan, dietetic review, screen for diabetes
||Glucose tolerance test, growth scan, review risk
||Growth scan, anaesthetic review, delivery plan, review risk
Review delivery plan if indicated
Post-dates plan if required
Discuss postnatal weight management/contraception
The preterm birth clinic
At NHS Lothian and University of Edinburgh we provide a specialist antenatal clinic for women who have a higher risk of having a preterm birth or late miscarriage. This Clinic is the only specialist service of its type in Scotland and since its inception in 2016. The clinic follows NICE guidelines on the provision of care for women with risk factors for preterm birth.
Attendance at specialist preterm antenatal clinic is considered to be an important approach to improve maternity, pregnancy and neonatal outcomes. Once a week the clinic sees around 16 antenatal women who have appointments from around 16 weeks of pregnancy. In very high risk cases women are seen at the clinic within the first few weeks of pregnancy. There is a multidisciplinary approach to staffing and clinic staff coordinate referrals to other specialities if further support required.
The clinic cares for women in NHS Lothian who have one or more of the following risk factors for preterm birth
- spontaneous preterm birth (<34 weeks gestation)
- preterm prelabour rupture of membranes (<34 weeks gestation) in previous pregnancy
- one or more spontaneous mid-trimester loss (16-34 weeks) in previous pregnancy
- short cervix on routine ultrasound (<25mm)
- previous cervical stitch/cerclage
- pre-pregnancy stitch/cerclage
- two or more LLETZ treatments
- knife cone biopsy to cervix
- trachelectomy for carcinoma of cervix
- uterine abnormality
Referral is made through your midwife, GP, obstetrician or neonatologist.
All women attending the clinic are offered cervical length scanning and infection screening and the women found to be at the highest risk are given treatments in an attempt to prolong their pregnancy. All care provided is within the same clinical setting thus minimising the need for multiple appointments. Women are also given the opportunity to take part in one or more research study which helps to further knowledge in the management of preterm birth. Data from women attending the clinic is also stored anonymously on the National Preterm Clinical Network Database and may be used for relevant research studies.
We actively train our obstetric and midwifery staff in management of women with risk factors for preterm birth and cascade our teachings throughout NHS Lothian.
The clinic also cares for postnatal women who have suffered either the loss of their baby or the birth of a very preterm infant with the purpose of reducing risks in a subsequent pregnancy.