Integrated Care for High-Risk Pregnancies at New KKH STORK Centre

1/17/2022 5:21:00 PM | Defining Med

The article is contributed/written by KK Women's and Children's Hospital

To meet the increasing need for holistic tertiary-level obstetric care, KK Women’s and Children’s Hospital
(KKH) has launched the one-STop Obstetric high RisK (STORK) Centre to provide integrated care for
women with complex and high-risk pregnancies involving obstetric and medical specialists, nurses and allied
health professionals.

This one-stop, integrated service facilitates collaborative and multidisciplinary care, which helps not only to
optimise the preconception health of women with high-risk medical or obstetric conditions, but also to support
these pregnant women throughout the different aspects and stages of their pregnancy journey.

OUR SERVICES

Led by specialists from KKH’s Department of Maternal Fetal Medicine, the new centre comprises eight clinics all located on the KKH campus.

Clinic	Services	Referral Criteria (non-exhaustive)
Obstetric High Risk Clinic (OHRC)	Consultant-led clinic for mothers with high-risk pregnancies	Hypertensive disorders of pregnancy (e.g., pre-existing hypertension, gestational hypertension, preeclampsia) Gestational diabetes mellitus on insulin Compromised adverse outcomes in previous pregnancy Stillbirth Uterine rupture History of severe preeclampsia HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome Eclampsia Morbid obesity Known or suspected case of placenta accreta Anticipated complicated deliveries (e.g., large uterine fibroids in pregnancy)
Joint Diabetes in Pregnancy Clinic (OBSDM)	Combined clinic run jointly by a consultant endocrinologist or internal medicine specialist and a consultant maternal-fetal medicine specialist	Pre-existing diabetes mellitus Gestational diabetes mellitus on insulin with suboptimal control
Joint Medical Disorders in Pregnancy Clinic (OBSMED)	Combined clinic run jointly by an internal medicine specialist and a consultant maternal-fetal medicine specialist	General medical disorders including: Hypertension Thyroid disorders Neurological conditions (e.g., epilepsy, previous stroke) Respiratory disease (e.g., poorly-controlled asthma) Cardiac disease Renal disease Obstetric cholestasis Rheumatological conditions Malignancy in pregnancy
Joint Obstetric and Haematology Clinic (OBSHAEM)	Combined clinic run jointly by a consultant haematologist and a consultant maternal-fetal medicine specialist	Previous history or current history of venous thromboembolic disease Platelet disorders (e.g., immune thrombocytopenia purpura, gestational thrombocytopenia) Complex anaemias (e.g., thalassemia major or intermedia) Thrombophilia Patients on long-term anticoagulation
Joint Obstetric and Dermatology Clinic (OBSSKIN)	Combined clinic run jointly by a consultant dermatologist and a consultant maternal-fetal medicine specialist	Moderate-to-severe skin problems (e.g., psoriasis, pustular psoriasis, atopic dermatitis, immunobullous disease) requiring immunosuppressants or systemic therapy such as cyclosporin, prednisolone or biologics Underlying autoimmune skin conditions (e.g., subacute lupus, anti-Ro/anti-La antibodies) Pemphigoid gestationis, intrahepatic cholestasis of pregnancy (with refractory itch), atopic eruption of pregnancy (requiring phototherapy or immunosuppressants) Women planning to start a family with skin problems requiring immunosuppressants or systemic therapy
Preterm Birth Clinic (OBSPRETERM)	Consultant-led clinic for mothers at increased risk for preterm birth	Past history of cervical incompetence or cerclage Current short cervix or cervical dilation on scan History of spontaneous preterm birth or premature prelabour rupture of membranes (PPROM) before 34 weeks of gestation in previous pregnancy History of mid-trimester pregnancy loss Previous cervical surgery (e.g., cone biopsy) Uterine malformations (e.g., uterine didelphys)
Twin Clinic (OBSTWIN)	Consultant-led clinic for mothers with multiple pregnancies	Dichorionic diamniotic (DCDA) twin pregnancies Monochorionic twin pregnancies Higher-order multiple pregnancies
Obstetric Pre-Pregnancy Counselling Clinic (OBSPPC)	Consultant-led clinic for women with existing medical problems or previous adverse pregnancy outcomes, who require pre-pregnancy counselling and optimising before their next pregnancy	Women with existing medical problems (e.g., rheumatological conditions, renal disease, cardiac disease) who require pre-pregnancy counselling and formulation of a pre-pregnancy plan prior to trying to conceive Women with previous adverse obstetric outcomes or complications who are considering embarking on their next pregnancy

HOW GPs CAN REFER

GPs who would like to refer patients to the STORK Centre can complete the referral form, and email it to [email protected].

Urgent requests for patient referral can be made to the STORK Centre clinic coordinator at 6394 8901 during office hours (Mondays to Fridays, 8am - 5pm).