Specialist clinics

For pregnant women who decline blood (including Jehovah’s Witnesses), we offer an individualised service which provide antenatal counseling, as well as intrapartum and postpartum care.  Haemorrhage is a particular concern and the service highlights the importance of optimizing predelivery iron stores (with haematinic and/or erythropoietin treatment), together with a bespoke care plan, taking into account the Royal College of Obstetricians and Gynaecologists’ Guidelines for women who decline blood products during pregnancy. Our unit has expertise in conservative surgical management of postpartum haemorrhage as well as access to intraoperative cell salvage (full time) and interventional radiology (weekdays).

We work in collaboration with Jehovah’s Witness Hospital Liaison Committee to support members in avoiding blood and blood products during their pregnancy.

Meet our team

• Dr Wai Yoong

Useful websites

RCOG 2011. Green top Guideline 63. Antepartum Haemorrhage.

RCS 2006. Code of Practice for Surgical Management of Jehovah’s Witnesses.

Currie J, Hogg M, Patel N, Madgwick K, Yoong W. Management of women who decline blood and blood products in pregnancy. The Obstetrician and Gynaecologist 2010; 12: 13–20.

 

Birth Options Clinic

At North Middlesex Hospital you are in control of all decisions about your labour and birth. Midwives and doctors have a duty to discuss all care recommendations, so you are fully informed of the risks and benefits. Once you have this this information, you decide what is right for you.

North Middlesex run twice-weekly Birth Options clinics with the Consultant Midwives. These clinics are perfect for you should you wish for a birth that may not be recommended to you. For example, if you have a medical complication but would like to consider homebirth or birth centre birth. Please discuss this with your midwife and ask for a referral to the Birth Options clinic

Maternal Choice Caesarean Section

You may wish to consider a planned caesarean rather than giving birth vaginally. Even if there are no medical indications but you would like to choose a planned caesarean section this is an option for you. Please discuss this with your midwife and ask for a referral to the Birth Options clinic. At this appointment the Consultant Midwife will discuss all the risks and benefits and discuss what is important to you. If, following this appointment you would like to go ahead with a planned caesarean section, you will see an obstetrician to complete the paperwork, and the caesarean will be booked. Please see the information on ‘Planned Caesarean’.

Whatever your choices and wishes for your birth, the Consultant Midwives will discuss all the risks and benefits, and the decision is yours, and yours alone. As the Royal College of Midwives state: ‘Your body, your baby’.

Place of birth

We have three settings in which you can choose to give birth: homebirth, birth centre and the labour ward. There is more information about these option on the ‘Your Birth at North Mid’ section.

Your midwife will discuss with you which setting is right for you. If you are experiencing a straightforward pregnancy and you are fit and well, a midwifery led homebirth or midwife led birth centre birth will be recommended to you. This is because you are more likely to have uncomplicated birth and it is safe for your baby. Women often feel very positive about their births in these settings. Equally, if you don’t have any complications but would prefer to birth on the Labour Ward, this option is there for you.

If you are experiencing any complications in your pregnancy, the midwives and obstetricians may recommend you give birth on the Labour Ward, as you and your baby can be more closely monitored here. The labour ward has a team of dedicated midwives and doctors to support you and has a beautiful pool room with waterproof monitoring.

What we offer

The birth reflections clinic runs on Thursday mornings and is offered to women who have had complications at or around the time of delivery. We aim to see women 4-6 weeks after birth and provide a robust clinical review, with a discussion and debrief around the events that occurred. We support women to ensure they understand what happened at their delivery and make any appropriate arrangements for ongoing support. We give advice concerning any future pregnancies and care.

We would usually see women with the following complications:

• Severe pre-eclampsia
• Massive bleeding after delivery (>2.5 litres or needing >4 units of blood transfusion)
• Admission into ITU for any reason
• Failed instrumental delivery leading to Caesarean section
• Category 1 Caesarean section (urgent emergency for low fetal heart rate, placental separation or cord prolapse)
• Baby required admission to SCBU for over 24 hours for reduced oxygen levels at birth
• Complicated Caesarean sections
• Prolonged hospital stay of more than 7 days after delivery
• Repeat operation after delivery
• If your consultant feels it is appropriate

If we see you in this clinic we aim to explain events in a way that you understand and answer all of your questions to the best of our ability. If you have any concerns to raise then we can take action as necessary

Meet the team

• Miss V Sivashanmugarajan - Consultant obstetrician
• Janet Pardo - Midwifery matron

How you get referred

Usually you would be given an appointment prior to discharge from the maternity ward. 

If you would like to be seen in the birth reflections clinic but don’t have an appointment then please speak to your midwife or GP who will refer you to the clinic. 

What we offer

Women with pre-existing diabetes women (Type 1 & 2) will have an urgent referral from their GP, Endocrine specialist, Specialist Diabetes nurse, self, or from the A&E department to the Maternity. Standard practice booking would be carried out by the Diabetes Specialist Midwife between 6 - 7 weeks or within 1 week of receiving the referrals. After booking, is completed the pre-existing diabetes pregnant women will then be:

1. Referral to the Multi-disciplinary diabetes clinic within 1- 2 weekly depending on their diabetes control
2. Referral for Retinal screening
3. Referrals for Fetal Echo cardiology scan
4. Referrals to the Dietician
5. Referrals for serial scan (this is done in line with the GAP growth)
6. All pre-existing Diabetes women are caseloads by the diabetes midwives from the first point of contact to discharge
7. This is a guide at how often these clients will be seen by the Diabetes specialist midwives (16, 20, 24, 34, 38 weeks of gestation)
8. All Pre-existing women will have the opportunity to have a discussion of their individual care plans between 34 – 36 weeks gestation.
9. The diabetes midwives will have conversation with the women regarding colostrum harvesting from the first point of contact and throughout the pregnancy depending on the woman’s choices. Parenting classes are carried out by the core midwives to help the women to get acquainted with the community midwives for their postnatal period

Gestational diabetes(GDM)

The specialist diabetes midwife will:

• Discuss GDM and teach the women self BM monitoring
• Give dietary and lifestyle changes advice
• Explain the importance of good glycaemic control during pregnancy
• Refer the woman to the MDT Diabetes Clinic
• Refer the woman to the dietitian
• Caseload the GDM women, (If their diabetes control continues to be diet controlled, they have seen in the MDT clinic for first review and at 36 weeks gestation.
• The GMD women on medication not well controlled will share care with the MDT.
• The diabetes midwives will have conversation with the women regarding colostrum harvesting from the first point of contact and throughout the pregnancy depending on the woman’s choices. Parenting classes are carried out by the core midwives to help the women to get acquainted with the community midwives for their postnatal period.

Management of pregnant diabetes patients admitted for antenatal steroid administration

Depending on the control of the woman’s blood glucose (pre-existing and GDM) steroid may be required.  A member of the MDT will:

• Book the woman with her contact number in the labour ward diary
• The woman will be admitted on labour ward for a minimum of 24 hours

Postpartum care: Pre-existing Diabetes

• Regardless of the mode of delivery (Caesarean / vaginal) the insulin sliding scale will stop after two consecutive reading of 7mmol. The woman will need to be encouraged to start eating and drinking as soon as she can.
• The woman will need to go back to her pre – pregnancy medication dose if the woman has a vaginal delivery on insulin infusion immediately after delivery once eating and drinking normally.

GDM

• All medication should be stopped for GDM women at the delivery. Advice on breast-feeding is encouraged, but the mother may need to increase the carbohydrate content of her diet as required. Advise on the Caring Together / Transitional Care Scheme
• Advise generally on the risk of GDM in subsequent pregnancy; for women with GDM Benefits of weight control, diet and exercise. Importance of contraception and pre-pregnancy care. The importance of fasting blood glucose

Meet the team

Consultant obstetrician 

• Mr OPARA, Elexie
• Ms KULKARNI, Ashwini
• Ms KARTHIKEYAN, Akila
• Mr ADEYEMO, Adewale

Endocrinology

• DR GARG, Anukul
• Dr RAYANAGOUDAR, Girish
• Dr Menon, Ravi

Midwives

• Dian Bates
• Hani Mohamed

Dietician

• Ana Correia

Nurse 

• Bridget Parkinson

How to get referred

NB:  Currently (due to COVID 19) all bookings are done by the core and community midwives.

 

What we offer

Women are referred to a fetal medicine unit when an abnormality is suspected during a routine scan in pregnancy, or if there is concern for the health of an unborn baby.

Our fetal medicine unit offers:

• diagnosis and management of fetal abnormalities
• management of complicated pregnancies
• invasive tests including chorionic villus sampling (CVS) and amniocentesis test to detect chromosomal abnormalities
• monitoring of women with Rhesus/ Kell allo-immunisation and other abnormal red cell antibodies
• management of monochorionic (sharing the same placenta) twin and higher order multiple pregnancies
• check for placental conditions like praevia/ accreta
• monitor the pregnancies with babies small for gestation with the use of ultrasound doppler examination

We run clinics Monday to Friday at The North Middlesex University Hospital. When you come to see us we will carry out a scan to confirm/ exclude the suspected diagnosis. If we find there isn’t an abnormality, we will reassure you and discharge from FMU and you will continue with your planned maternity care.

If the diagnosis is confirmed we will explain what this means and discuss in detail the options available for managing the condition. Depending on your condition you may continue to see us in the fetal medicine unit throughout your pregnancy. If it is anticipated that the baby will need extra support after birth, we will arrange antenatal consultation with our neonatal specialist to explain this and make a comprehensive care plan for baby after birth. We give advice concerning any future pregnancies and care. Our specialist midwife will support families during this difficult time and provides direct mobile access to answer queries.

For some conditions, such as twin to twin transfusion syndrome or fetal heart abnormality, you may need further assessment and treatment with another service. We work closely with our colleagues at Great Ormond Street Hospital and the fetal medicine centre at University College London Hospital to plan any care you require throughout your pregnancy and after your baby is born.

Meet the team:

• Miss Deepa Janga - consultant obstetrician
• Miss Abha Govind - consultant obstetrician
• Miss Ashwini Kulkarni - consultant obstetrician
• Barbara Mangwende – specialist midwife
• Dr Cheentan Singh- neonatal consultant

How you get referred:

If one of our sonographers suspects an abnormality during a scan they will let you know and refer you to see one of our fetal medicine specialists.

You could also be referred to us if there is any concern about the growth of the baby, the fluid around the baby during your pregnancy, or if a screening test shows you are at an increased risk of having a baby with Down's syndrome. If you have a previous baby with a known genetic/ congenital condition, you can ask your GP/ midwife for a referral in future pregnancy.

The referral can be sent to northmid.fmu@nhs.net.

What we offer 

Women with a higher BMI are at increased risk of complications in their pregnancies. To minimise these risks we see you in a high-risk obstetric clinic to ensure that you are offered the best care for you.  The hospital clinic focuses on women with a BMI >40 but will provide advice to all women with a BMI>30.

Pregnancy complications that are increased with a high BMI include miscarriage, gestational diabetes, pre-eclampsia (raised blood pressure related to pregnancy), baby being either smaller (growth restricted) or larger (macrosomic) than expected, premature birth, stillbirth, need for Caesarean delivery, wound infections after delivery and excessive bleeding related to childbirth. In view of these increased risks women with a higher BMI are offered an enhanced package of antenatal care.

Meet the team

• Consultant obstetrician - Miss Abha Govind
• Consultant obstetric anaesthetist - Dr. Shahrazad Tadbiri
• Dietician - Midwives Dian Bates

BMI is greater than 30 kg/m²:

• We recommend 5mg Folic Acid supplementation daily, starting at least one month prior to conception and throughout the 1^st 12 weeks.
• You will be offered screening for gestational diabetes with your booking bloods and a glucose tolerance test at 28 weeks gestation.

BMI is greater than 35 kg/m²:

• You will have a risk assessment for pre-eclampsia and may be offered Aspirin 150mg daily from 12 weeks to reduce this risk.
• You will have a risk assessment for venous thromboembolism (deep vein thrombosis DVT and pulmonary embolism PE) and may be offered a blood thinning medication to reduce this risk.
• You will be offered additional ultrasound scans in the third trimester to monitor the growth of your baby.

BMI is greater than 40 kg/m²:

• You will be seen in the Thursday morning high risk obstetric clinic.
• You will be offered Aspirin 150mg daily from 12 weeks to reduce your risk of pre-eclampsia.
• You will be offered an antenatal appointment with an Anaesthetist to discuss possible pain relief options for labour and in case a Caesarean delivery is required.
• You will be offered appointments with our dietician.  You may include extra vitamin D supplements.
• You will be seen more regularly throughout your pregnancy.

How you get referred:

At your booking appointment your midwife will measure your height and weight. If you are identified to have a BMI >40 kg/m² then you will be referred to the high-risk obstetric clinic by your midwife for ongoing care.

What we offer

At your booking visit all women are offered blood tests to screen for common conditions that could affect the mother and baby. These blood tests include an infection screen for HIV, Hepatitis B and Syphilis. We screen for these infections so that if they are detected in early pregnancy, we can prevent your baby catching these infections.

HIV

HIV is caused by a virus called retrovirus that prevents the body’s immune system from working properly and makes it hard to fight off infections. If you are HIV positive the virus can be passed to your baby through the placenta while you are pregnant, during the birth and through your breast milk. The care you will receive aims to prevent the risk of passing HIV on to your baby.

You will be seen by midwife Kay Francis for booking and obstetrician Miss Govind for pregnancy care in the Thursday morning high risk obstetric clinic throughout your pregnancy. We aim to control your HIV infection to reduce the risk of transmission to the baby and keep you well.  You will see Dr Chris Wood for this who will discuss and offer anti-retroviral treatment. You will have individualized care through your pregnancy and a birth-plan will be made by midwife Kay Francis based on your HIV control. Many women with good control achieve safe vaginal delivery of their baby. After your baby is born, the new born will be followed up by pediatrician Dr Daniels who will provide anti-retroviral treatment to reduce the baby’s chance of becoming HIV positive even further. We advise against breastfeeding as this can transmit the virus to the baby but this can be discussed with your HIV team during the course of the pregnancy.

Hepatitis B

Hepatitis B (HBV) is a viral infection affects your liver though many people are not aware they have the infection and have no symptoms.  If you are found to have Hepatitis B in pregnancy you will have blood tests to check your liver function and assess the type of infection in more detail.  You will be seen by the specialist liver team under the care of Dr Andrew Millar, obstetrician Miss Govind and midwife Kay Francis.  

The antenatal hepatitis clinic runs on a monthly basis to review all pregnant woman who have liver problems, particularly those with hepatitis B. With careful planning and treatment we expect to fully prevent hepatitis B transmission to babies. This is by vaccination, monitoring, and sometimes medication for the pregnant mother. The Hepatology team works closely with the midwives and obstetricians to ensure we look after all expectant mothers with liver problems. 

All babies are now offered vaccination against HBV in the first few months, though the first injection is given at birth if the mother has HBV. Some babies are also given immunoglobulin antibody against HBV at the same time.   In mothers with a high level of the virus, the mother is offered treatment with medication to reduce the level of virus as this further reduces the chance of the baby being infected with HBV.  The team  will provide support and counselling for you and advise testing your partner and children.  Importantly arrangements will be made for ongoing care in the Hepatology department for all mothers with hepatitis B.  

Hepatitis C

We do not routinely test for Hepatitis C in pregnancy, but all those considered at risk, including those with HIV or HBV, will be offered this test.  It is uncommon for Hepatitis C to be passed from mother to baby but all those with hepatitis C will be seen in the antenatal clinic to be offered counselling and plan treatment of the condition.  Hepatitis C can now be easily treated with tablets for 2-3 months and this is offered to the mother after the baby is born. 

Syphilis

Syphilis increases the risk of miscarriage, preterm birth, stillbirth and congenital syphilis.  A baby with congenital syphilis, if left untreated can develop physical and neurological impairments affecting the child’s bones, teeth, vision and hearing. If your screening blood tests are positive for syphilis then you will be seen and counselled by our midwife Kay Francis. Sometimes the result are false positive and further tests may be needed. You will be seen by Dr Loke for further management.  Syphilis is treatable with antibiotics, but should you have syphilis in pregnancy then your baby may need extra scans for close monitoring and Dr Loke will suggest screening for other sexually transmitted infections. If you are diagnosed with syphilis during your pregnancy and then your baby will be followed up by the paediatric team.

Meet our team

• Consultant obstetrician - Miss Abha Govind
• HIV physician – Dr Christopher Wood
• Hepatologists – Dr Andrew Millar, Dr Thendral Mangala
• Sexual heath consultant - Dr Wai Ching Loke
• HIV pediatrician – Dr Justin Daniels
• Specialist midwife – Mrs Kay Francis
• HIV paediatric clinical nurse specialist - Yolette Lees

How you get referred

If you are known to have any of these infections or if they are detected on your screening blood tests then you will be referred to the High-risk obstetric clinic by your midwife.

The joint haematology obstetric and the joint cardiologist obstetric specialist clinics occur on Thursday mornings and afternoons respectively, twice a month.

The named maternal medicine obstetrician for these clinics is Mr Adewale Adeyemo, who works in very close conjunction with the haematologist (Dr Sarah Barsam) and cardiologist (Dr Ron Simon).

The joint haematology clinic caters for women who are known to have haematological conditions such as both inherited (e.g. antithrombin deficiency) and acquired thrombophilias (e.g. antiphospholipid syndrome), haemostatic disorder e.g.Von Willebrand’s disease, Haemophilia carriers, low platelets and women who have had a blood clot during the index pregnancy or previously and require treatment with anticoagulants.

In the joint cardiology clinic, women who have pre-existing cardiac conditions (e.g. congenital or acquired heart lesions) or who develop cardiac related conditions during the course of the pregnancy are reviewed and managed. Any woman who is already booked for antenatal care at North Middlesex Hospital who is known or has a suspected heart disease is referred as early in pregnancy as possible. Most women attending the joint obstetric cardiology clinic will have as a minimum, maternal echocardiogram and a 12 lead ECG arranged and for those with a congenital heart lesion, fetal echocardiography is arranged through the Great Ormond Street Hospital.

Main referral to these clinics is from other obstetric consultants’ routine antenatal clinic or the haematology/cardiology outpatient clinics and from midwifery booking clinics. Women will also sometimes be referred following a haematological or a cardiology related complication during initial review in the acute setting or following an in-patient admission.

Women are seen jointly in these clinics within the multi-disciplinary team and with many patients we also involve the anaesthetic team to plan management around labour and delivery.

For women with complex haematology diagnosis and high risk cardiac lesions, we have a close working relationship with the local tertiary referral centres to decide ideal location for antenatal care and also for delivery.

Our Lotus Clinic is a specialist clinic to manage patients with history of drug and alcohol misuse prior to being pregnant.

What we offer

This is a comprehensive multi -disciplinary clinic to support and care for women with history of substance misuse in pregnancy.

It involves joint care with specialist midwife, local (Haringey and Enfield) drug and alcohol services, Social services of the Enfield and Haringey Boroughs as well as the Mental Health Service team as may be needed.

Patients are stratified following screening at booking and an appointment is made to see the obstetric consultant and the lead midwife for the service in ANC.

Urine toxicology screening is routinely done and depending on the results – patients may be returned to regular pathway or care planned to accommodate needs in line with a positive test for drug use.

Clinics take place every Friday morning with review both by lead midwife and consultants as may be necessary. Regular antenatal services are provided which will include clinical examination and ultrasounds examination as may be necessary.

Due to the nature of the problem – child protection related issues may be raised and planned for as appropriate.

Meet our team

• Lead Consultant: Mr Abiodun Fakokunde
• Lead Midwife for Substance misuse: Changu Tsiga
• Named Midwife for Child Protection: Chantel Palmer

Referrals to the specialist clinic can be done:

• Support services for drug and alcohol misuse within the boroughs of Haringey and Enfield
• Midwife following booking for antenatal clinic
• Mental health services within the boroughs.

Maple is a community-based psychological therapy service for people who are experiencing emotional distress due to difficult birth-related experiences or the loss of a baby. We are a dedicated team of clinical/counselling psychologists and a peer support worker (someone with lived experience of birth-related trauma).

We see

We offer therapeutic support to people whose level of distress is significantly interfering with their quality of life. Distress may be related to the following areas:

Fear of childbirth (tokophobia)

Where a wanted pregnancy may be delayed or terminated due to fear, or fear is causing significant levels of distress in a current pregnancy. People may be referred before any experience of pregnancy or childbirth.

Birth trauma

Where someone has experience of a traumatic birth.  This may be directly experienced or witnessed. The level of distress might be impacting daily life, preventing a wanted pregnancy and/or causing raised levels of stress in a current pregnancy.

Perinatal loss 

This might be loss associated with difficulties arising from fertility treatment, miscarriage, termination, loss of a baby due to a medical condition, stillbirth or neonatal death.  Including complex grief reactions and when a baby is born with a medical condition/disability.

Loss of a child due to safeguarding concerns

This includes working with parents whose babies (under one year old) have recently gone into care or when there are concerns about an unborn child.

We work with people living in the boroughs of Enfield or Haringey who are:

• Planning a pregnancy OR currently pregnant OR have had a baby in the past 13 months

AND

• Have symptoms of trauma as a result of their fertility, pregnancy or birth-related experience or loss of a baby
• This includes fathers and/or partners
• People who are pregnant must be under the care of North Middlesex University Hospital  

Age range treated: 18+

What to expect

Our goal is to see people within six weeks of receiving the referral. If the referral is deemed urgent, we aim to see people sooner. 

People will generally be seen in the hospital, community, at home or virtually.  We can work with people throughout the perinatal period (prior to conception and up to two years postnatally, as appropriate).

We aim to offer flexible and individualised psychological assessment and intervention which may include:

1. Individual or couple evidence-based psychological therapy (e.g. Trauma-Focussed Cognitive Behavioural Therapy, Narrative Exposure Therapy, Eye Movement Desensitization & Reprocessing (EMDR), Compassion Focussed Therapy)
2. Peer support
3. Specialist advice, training, consultation and co-working with referrers and related health professionals
4. Specialist liaison with North Middlesex University Hospital maternity colleagues

Our aims:

• To improve the health and wellbeing of people who are experiencing symptoms of trauma that have arisen as a result of a pregnancy-related experience or the loss of a baby.  We follow the NICE guidelines on Antenatal and Postnatal Mental Health. 
• We will work collaboratively with families/carers, and various other statutory and voluntary services i.e. maternity services, obstetricians, health visitors, secondary mental health services and GPs to ensure good partnership working to support a person’s physical and mental health needs. 
• We are active with teaching and training other health professionals so that they can have a good working knowledge of how mental health problems and birth related trauma can affect people in pregnancy and after birth and to help services provide trauma-informed care.

Contact

020 3317 7114

cim-tr.ncl.perinatal@nhs.net

What we offer

This is a specialist clinic with the aim is to reduce the risk of late miscarriage and preterm birth in women who might be at risk of this.

If you have been referred to the preterm birth clinic it is because you have one or more risk factors which may put you at risk of having a baby born preterm.

Most pregnant women give birth to their baby after 37 weeks of pregnancy, called ‘term birth’. About 8 in 100 women give birth to their baby before 37 weeks of pregnancy. If a baby arrives just a few weeks early then the prognosis is generally excellent, but if they arrive a few months early then the outlook can be very different.

We see women who may have an increased risk of giving birth preterm such as:

• If you have had a previous spontaneous preterm birth before 34 weeks or a late miscarriage (16 weeks or more into pregnancy)
• If you have had surgery on your cervix (neck of the womb) such as a cone biopsy or large loop excisions of the transformation zone (LLETZ)
• If you have had surgery on your womb such as resection of a uterine septum or treatment for Ashermann's syndrome
• If your womb is an unusual shape such as a unicornuate uterus
• If your cervix has been found to be shorter than normal by ultrasound
• If you have had a stitch placed in your cervix (cervical cerclage) in a previous pregnancy or in this pregnancy
• If you have had a previous Caesarean birth when your cervix was fully dilated.

What can I expect?

We will take a full history to identify your risk factors for preterm birth.

At your first visit we may offer vaginal swabs to look for infections in the vagina. We also test your urine for infection.

We measure the length of the cervix (neck of the womb) using a vaginal ultrasound scan. This is an internal scan and you will be asked to empty your bladder before the scan.

If the cervical length is shorter than usual we may recommend treatment such as a cervical cerclage (stitch) or vaginal progesterone (hormone treatment).

Depending on the initial assessment you may be followed up until 28 weeks.  This will be in addition to your normal antenatal care.

Meet the team

• Ms Alison Wonnacott – Consultant Obstetrician & Gynaecologist
• Dr Narmen Maulod – Specialty Registrar in Obstetrics & Gynaecology
• Ms Jasmin Dwumah – Specialist preterm birth midwife

How do I get referred?

If you have risk factors for preterm birth/late miscarriage, the midwife booking the pregnancy will refer you to the clinic at the onset of the pregnancy.  We aim to see you first between 12 and 16 weeks depending on your risk factors. Other women may be referred up to 26 weeks of pregnancy if their risk factors are only identified later. If you think you might be eligible for the preterm birth clinic, please discuss this with your midwife.

What we offer

Sickle cell disease is a group of inherited health conditions that affects red blood cells. The most serious type is called sickle cell anaemia, in which red cells have a different shape to normal red cells.  This affects their ability to carry oxygen around the body and can lead to ‘sickling’ when blood cells clump together blocking blood vessels, causing pain and other problems such as serious infections, strokes and lung problems.

If you have sickle cell disease then you may already be accessing care with the sickle cell service. The haematology department at North Middlesex Hospital is one of the 24 Specialist Haemoglobin Disorder Centres commissioned to provide this care. If you are thinking about having a baby then we recommend that you discuss this with your haematologist so that they can ensure that you are taking the correct medications.

Screening for sickle cell disease in pregnancy is offered to all pregnant women in North Middlesex University Hospital to check if there is a risk of a child being born with the condition.  The nursing team at the George Marsh Centre for sickle cell and thalassaemia at St Ann’s Hospital provide antenatal counselling for haemoglobinopathies.  They also manage newborn screening results - all babies are offered screening for sickle cell disease as part of the newborn blood spot test (heel prick).

Some milder cases of sickle cell disease and thalassaemia are detected with pregnancy screening blood tests. Even if you have mild disease it is important that you are seen by our specialist team in your pregnancy to minimise your risk of complications.

In the pregnancy clinic you will be seen by Miss Govind’s team.  They, jointly with your haematologist will ensure you have a personalised plan of care for your pregnancy. You will be offered partner screening for sickle status.

In addition to usual pregnancy care you will be offered infection screens, tests of your lung function, eye screening, a review of your kidney function with a blood test and regular urine testing, as well as an echocardiogram.  The haematology team will arrange top-ups or automated red cell exchange blood transfusions if you should require it.

We recommend that women with sickle cell disease take a mini Aspirin from 12 weeks of pregnancy and high dose Folic Acid (5mg once a day) from 3 months prior to trying to conceive and throughout pregnancy. Most women will be taking folic acid anyway already as part of their sickle cell management.

Your baby is at increased risk of being small and of delivering early and so we will offer you regular scans to monitor your baby’s growth in the third trimester (from 28 weeks). You are also at increased risk of blood pressure problems in your pregnancy and so we will monitor you closely for this.

If you are unwell, we recommend that you attend hospital early so that we can treat you promptly and minimise complications.

As you have increased risk of blood clots, if you are unwell, we will offer blood thinning medication. We also offer this to all women with sickle cell disease from 28 weeks in pregnancy and after the baby is born as this is the highest risk time for blood clots

Meet the team

• Consultant obstetrician:  Miss Abha Govind
• Consultant haematologist: Dr Arne de Kreuk
• Sickle cell and thalassemia specialist nurse: Ms Liz Odeh
• Maternity screening Co-ordinator: Carole Shibley
• Pre and early pregnancy counselling: George Marsh Centre, St Ann's Hospital

How you get referred

If you are known to have sickle cell disease or if it is detected on your screening blood tests then your midwife will refer you to the high-risk obstetric clinic after your booking appointment. You will be seen there at 16 weeks gestation or earlier.
 

What we offer

The majority of teenage pregnancies are unplanned and Research has shown that teenage pregnancy is associated with poorer outcomes for both young parents and their children. At North Middlesex University Hospital we offer an enhanced care pathway for women under the age of 19 when they become pregnant.

Timely access to appropriate care and support can help avoid poor outcomes and maximize chances of a positive transition to parenthood. We aim to create an environment which is welcoming to young women and young men. We offer antenatal appointment in the local community children centre if this is more appropriate. The team offers information and emotional support specifically for teenage pregnancy. The Consultant led clinic runs every Monday afternoon at The North Middlesex University Hospital.

North Middlesex University Hospital NHS Trust works in partnership with Enfield and Haringey, supporting the teenage pregnancy strategy through multi agency working and information sharing to support teenage parents. We have developed links with community groups that give support specific to Teenagers during pregnancy including Family Nurse Partnership programme and financial support officers. We also offer a variety of opportunities to access Parentcraft sessions.

Meet the team

• Miss Deepa Janga - Consultant Obstetrician
• Chantel Palmer – Midwife for Safeguarding
• Changundega Tsiga- Child-protection Midwifery Adviser

How you get referred

If you are pregnant aged 19 yrs or younger, the midwife conducting the booking visit will refer you to the team for further pregnancy care. If you would like to be seen in the Teens clinic but don’t have an appointment then your midwife or GP is able to refer you by contacting us.