Medical Disorders in Pregnancy: A manual for midwives



Medical Disorders in Pregnancy: A Manual for Midwives

Author details – in alphabetical order

Editors

S. Elizabeth Robson RGN RM ADM Cert(A)Ed MTD MSc FHEA

Principal Lecturer in Midwifery; N&M Recruitment and Public Engagement Lead at De Montfort University

After staff nurse experience on medical and gynaecological wards in Cambridge, Liz qualified as a midwife and had 5 years of hospital experience prior to winning the Jack Kerr Memorial Award for Trent Regional Health Authority. Her ADM was attained in Bristol, educational qualifications from Nottingham University and an MSc in research methods from Loughborough University. With 25 years experience as a midwifery lecturer, she leads a module on medical disorders for student midwives with a particular interest in immunology. Her clinical liaison areas comprise a community team and a high-risk maternity ward. Liz has presented nationally, and has a number of publications.

Jason Waugh MB BS BSc(Hons) MRCOG DA

Consultant in Obstetrics and Maternal Medicine at the Royal Victoria Infirmary, Newcastle upon Tyne and Honorary Senior Lecturer at the University of Newcastle upon Tyne and the University of Leicester

Jason trained in maternal medicine in Sheffield, New Zealand and Leicester before working as a consultant in Leicester for 5 years. He is now lead consultant for maternal medicine in Newcastle upon Tyne and has established maternal medicine training programmes for obstetricians in both cities. His current research interests are hypertension in pregnancy and renal and cardiovascular disease in pregnancy and he has published extensively in these fields as well as producing national guidelines for the management of pre-eclampsia and renal disease. He is president of the UK Macdonald Obstetric Medicine Society.

Midwifery and Nursing Authors

Abena Addo MA PDGE BSc RGN RM

Senior Lecturer in Midwifery at De Montfort University

After staff nurse experience in general surgery at the Royal Masonic Hospital in London, Abena trained as a midwife in Surrey, followed by midwifery practice at The Royal Free Hospital, London where she developed an interest in the care of women with sickle cell anaemia in pregnancy and their coping strategies. Abena then undertook a BSc followed by an MA in teaching health care ethics at the University of London. With 14 years experience as a midwifery lecturer she teaches midwifery, haematological disorders, ethics, and contemporary midwifery practice with a keen interest in global midwifery and health issues.

Eleanor Burns-Kent RM BSc (Hons)

Midwife at the University Hospitals of Leicester NHS Trust

Eleanor has worked full time in all aspects of midwifery within the hospital setting since qualification in 2000. For the past 8 years she has worked in a high-risk delivery suite setting with a passion for trying to normalise childbirth for the high-risk pregnant woman.

Rhoda Cowell BSc(Hons) RGN DipEd

Community Dermatology Specialist Nurse and Non-Medical Prescriber at County Durham and Darlington Foundation Trust

After 20 years of community nursing Rhoda specialised in dermatology and was involved in the development of community dermatology and minor surgery services throughout Sunderland. She currently runs nurse-led clinics for dermatology, cryosurgery and soon minor surgery.

Claire Dodd RGN BA(Hons) RM BSc(Hons)

Specialist Midwife in Hypertension at the University Hospitals of Leicester NHS Trust.

Claire worked as a staff nurse in haematology before undertaking her midwifery training in 1997. She has had a keen interest in the hypertensive disorders of pregnancy since 1999 and has been involved in a number of research projects including the Magpie Trial and GOPEC. Claire has been working as a specialist midwife since 2006.

Rowena Doughty MSc PGDE BA(Hons) RGN RM ADM FHEA

Senior Lecturer in Midwifery, Supervisor of Midwives and Deputy Lead Midwife for Education at De Montfort University

After staff nurse experience in general medicine and gerontology, Rowena qualified as a midwife and accrued 12 years full-time midwifery experience in Lincolnshire, before her lectureship with De Montfort University in 1997. She is also able to maintain effective links with practice through working within a local birth centre. Rowena is a Nurse Medic providing initial treatment to victims of emergencies in her local and very rural community prior to the arrival of the Ambulance Services. Her interests include promoting normality in normal midwifery, breast-feeding, resuscitation and metabolic disorders. Rowena is undertaking PhD research exploring women’s lived experiences of being obese while childbearing.

Daksha Elliott RGN RSCN

Lead Nurse/ Manager, Leicestershire Sickle Cell & Thalassaemia Service at the University Hospitals of Leicester NHS Trust

Daksha currently works with a multidisciplinary team to provide education, support and co-ordination of care for patients with haemoglobinopathies.

Caroline Farrar RGN RM BSc(Hons) PGDipEd MSC

Senior Lecturer in Midwifery at De Montfort University

After working as a staff nurse in burns and plastic surgery Caroline qualified as a midwife and experienced all areas of midwifery including integration of midwifery practice. It was noticeable that her enthusiasm was within the delivery suite environment and thus studied an MSc in midwifery which in turn focused her energy into becoming a midwifery lecturer.

Madeleine Findlay RGN RM BSc (Hons) PG Cert Education and Training

Currently Parent Education Co-ordinator at the Royal Victoria Infirmary, Newcastle upon Tyne

Madeleine has worked as a Midwife since 1994 in community and hospital settings and for 10 years has focused on the needs of vulnerable clients. From 2007 to 2010 she worked as a senior midwife for drugs and alcohol in Newcastle and prior to this was a Sure Start midwife in an inner city area. She has organised and presented on drugs and alcohol in pregnancy and associated issues at a number of regional events and has taught on the midwifery education programme at Northumbria University on the topic of vulnerability for some years.

Deborah Frost RGN RM BSc (Hons) AHEA

Academic Co-ordinator at the University of Leicester

Debbie qualified as a nurse in 1986 and as a midwife in 1988, specialising in high-risk pregnancy and care. She was the lead midwife for the Maternal Medicine Clinic at Leicester for 3 years. A scholarship enabled her to study epilepsy care at diploma level at Leeds Metropolitan University. She teaches at the University of Leicester where she is co-module lead for an Inter-professional learning community programme for graduate and undergraduate medical students. Debbie is also an experienced senior NLS instructor for the UK Resuscitation Council and continues to champion the role of the midwife.

Michelle Goldie

Formerly Specialist Midwife at the University Hospitals of Leicester NHS Trust, Leicester

Michelle Goldie trained as a midwife in Leicester and has published research presented at the American Thoracic Society.

Andrea Goodlife RM Dip.Renal nursing

Specialist midwife in hypertension and renal disease at the University Hospitals of Leicester NHS Trust

After 2 years as a nephrology unit staff nurse, Andrea undertook midwifery training, and has practised since 1988. The combined renal/obstetric clinic was set up in 1998, and by furthering her education by completing the Diploma in Renal Nursing, Andrea has been involved in this clinic since its outset.

Kathryn Gutteridge RGN, RM, SoM, MSc, PG.Dip Counselling & Psychotherapy

Consultant Midwife at the Sandwell and West Birmingham Hospitals NHS Trust

Kathryn founded a postnatal illness support group in Tamworth. This project was highly commended in the RCM Centenary Awards. She began her postgraduate training in integrative psychotherapy culminating in research into psychodynamic transition to motherhood. In Leicester Kathryn worked in developing midwifery led care and latterly in supporting women’s mental health and wellbeing. Kathryn is regarded as an expert advisor in women survivors of sexual abuse and the impact this has during childbirth; she regularly presents on this subject. Kathryn is a member of the Expert Advisory Committee for the East Midlands Perinatal Psychiatry Clinical Network.

Juliet Houghton MSc Dip RGN RSCN ENB:934

Recently the Child and Family HIV/Hepatitis Specialist Nurse at the University of Leicester Hospitals NHS Trust, and now Programme Director of CHIVA/KZN Support and Mentoring Initiative based in Durban, South Africa

Juliet worked on neonatal units and a paediatric oncology ward before qualifying in HIV nursing. She then attained a diploma in Tropical Nursing at the London School of Hygiene and Tropical Medicine. More recently, she has graduated from Brunel University with an MSc in the Social Anthropology of Children and Child Development.

Juliet won the medical category of the ‘Barnardo’s Children’s Champion’ award for 2005.

Veronica Johnson-Roffey BA(Hons) RGN RM RHV FETC Dip.Infection control

Infection Control Lead Nurse at Northamptonshire NHS Trust

Veronica worked in the NHS for 35 years. After general nurse training she trained and practised as a midwife and later health visitor and consequently has worked both in hospital and community. During her career she has also worked at Great Ormond Street Children’s Hospital and also specialised in cancer genetics, public health and infection control. While a public health nurse she undertook her honours degree in Health and Social Policy at Warwick University. Recently she retired from the NHS and now works in the private healthcare sector

Rosemary Lydall RGN RM BA (Hons)

Infant Feeding Coordinator - Women's, Perinatal and Sexual Health Clinical Business Unit at the University Hospitals of Leicester NHS Trust

After working as a staff nurse in orthopaedics, Rosemary trained as a midwife in 1985. Rosemary is experienced in all areas of midwifery within the hospital setting, and has an interest in gastrointestinal disorders. In 2000, Rosemary became a Supervisor of Midwives, which enhances all aspects of the care that Rosemary gives to women and the support she can offer to her colleagues.

Moira McLean RGN RM ENB:402 ADM PGCEA MTD PGDip SoM

Senior Lecturer in Midwifery at De Montfort University

Moira has been teaching student midwives for over 20 years and has specialist interest in normal midwifery, fetal heart monitoring, neonatal resuscitation and maternal resuscitation. She is an ALSO course trainer, and external examiner to three centres in the UK. Moira maintains a caseload of mothers in clinical practice and is a voluntary breast-feeding advisor.

Jane Scullion BA(Hons) RGN MSc

Respiratory Nurse Consultant at University Hospitals of Leicester NHS Trust; Honorary Senior Lecturer at De Montfort University; Clinical Research Fellow at Aberdeen University

Jane Scullion is a Respiratory Nurse Consultant working across the interface of primary and secondary care with patients with chronic respiratory diseases and developing respiratory services within Leicestershire. She has published widely and presented both nationally and internationally

Diane Todd BSc(Hons) DipHE RM RGN

Specialist Midwife - Diabetes at the University Hospitals of Leicester NHS Trust

Diane trained as a staff nurse in 1984 and gained several years experience in Surgical Speciality and Intensive Care Nursing, after which she chose a career in midwifery. Qualifying in 1992 much of her practice has focused on high-risk pregnancies, in particular those women who have diabetes. As part of a multidisciplinary team she has further developed the care and service offered to these women, winning a Trent Travel Award in 1995, for a Leicester Team to visit Edinburgh Royal Infirmary to learn more about pre-conception clinics and actively participating in the recent CEMACH Diabetes in Pregnancy Study. She has also undertaken specific courses to enhance her knowledge and skills and has presented at national and international level.

Medical Authors

Professor Fionnuala McAuliffe MD, FRCOG, FRCPI, DCH

Associate Professor in Obstetrics and Gynaecology, University College Dublin, Ireland and

Consultant Obstetrician and Gynaecologist and Maternal and Fetal Medicine Specialist, National Maternity Hospital, Dublin, Ireland

Fionnuala trained in maternal and fetal medicine in London and Toronto prior to her current appointment in Dublin. She is lead clinician for maternal medicine and diabetic pregnancy and Director of the maternal and fetal medicine sub-specialty programme at National Maternity Hospital, Dublin. Current research interests are diabetic pregnancy, maternal nutrition in pregnancy, fetal ultrasound and fetal growth. She is extensively published with over 75 publications in maternal and fetal medicine.

Christopher Brightling BSc(Hons) MBBS MRCP PhD FCCP

MRC Clinician Scientist and Honorary Consultant Respiratory Physician at the University Hospitals of Leicester NHS Trust, Leicester

Chris Brightling trained in London and Leicester and in 2002 was appointed Senior Lecturer and Honorary Consultant in Respiratory Medicine at Glenfield Hospital. His major research interests are the utilisation of inflammatory markers in the management of airway diseases and mast cell--airway smooth muscle interactions in the pathophysiology of asthma. He has authored over 50 peer-reviewed papers.

Professor Nigel J. Brunskill MB ChB, PhD, FRCP

Nephrologist at Leicester General Hospital and Senior Lecturer at the University of Leicester

After training as a nephrologist in Sheffield, St Louis, Missouri, USA and Leicester, Nigel became a Consultant Nephrologist in 1997. As a clinical academic, in addition to clinical responsibilities, he supervises a laboratory team investigating cellular mechanisms of kidney disease. His particular clinical interests include proteinuria, progressive renal disease and management of renal disease in pregnancy. He has published widely in the field of kidney disease.

Frances A. Bu’Lock MD FRCP

Consultant Paediatric Cardiologist at Glenfield Hospital, Leicester

Frances graduated from Cambridge and Oxford, and trained in congenital heart disease in Bristol, Birmingham and Liverpool before coming to Leicester in 1999. Her main clinical interests are in fetal and adult congenital heart disease, which fit remarkably well together. She is the Cardiology Associate Editor for Archives of Diseases in Childhood and has written extensively in the field of congenital and fetal heart disease. She is currently co-investigator for a large study into the genetics of congenital heart disease funded by the British Heart Foundation.

Francis J.E. Gardner BSc MB ChB MRCOG DFFP BSCCP accredited

Consultant in Gynaecology and Gynaecological Oncology and Clinical Director for Gynaecology at the Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust

 

Francis’ main area of expertise is in gynaecological oncology but he has a specialist interest in minimal access surgery for patients with gynaecological cancer. As a result of this he has led a number of service developments related to minimal access surgery such that the standard treatment for a number of common cancers such as endometrial cancer is now being performed using these techniques in the Queen Alexander Hospital Cancer Centre. This has led to a very significant improvement in service delivery for women with these cancers coming for treatment at this Cancer Centre. In addition to this Francis is leading on the development of a robotic surgery programme for patients with gynaecological cancer which in time should also provide a further very significant improvement in service delivery.

Catherine Gittins BM MRCGP DCH DRCOG DFFP DPD.

GP partner in Whitley Bay and Dermatology Specialty Doctor at the Royal Victoria Infirmary, Newcastle upon Tyne

Catherine passed the Diploma in Practical Dermatology (DPD) with distinction in 1999 and is

a member of the primary care dermatology society.

Julie Goddard MBBS DFFP MRCOG

Consultant Obstetrician at the Calderdale Royal Hospital, Halifax

Julie graduated from the University of Newcastle upon Tyne in 1998. Having completed her specialist registrar training in the North Eastern Deanery, she moved to Yorkshire in September 2008 to take up a consultant post. Julie has special interests in maternal medicine, high-risk obstetrics and intrapartum care. She is currently Clinical Lead for Obstetric Risk Management.

Robert Gregory BA MB BS DM FRCP

Consultant Physician and Head of Service, Metabolic Medicine at the University Hospitals of Leicester NHS Trust

Rob undertook research in the immunology of diabetes at University Hospital, where he developed an interest in the medical problems of pregnancy and in the management of pregnancy in diabetes in particular. In 1992 he published a controversial article questioning the value of pre-pregnancy counselling clinics for women with diabetes. He researched metabolic aspects of gestational diabetes in Cambridge. Since moving to Leicester he works in multiprofessional diabetic antenatal clinics. The team visited San Antonio in 1996 thanks to a Trent Regional Quality Travel Award to study the management of gestational diabetes in Hispanic women.

The late Edmund S. Howarth MB ChB MRCOG

Formerly Consultant in Maternal and Fetal Medicine at the University Hospitals of Leicester NHS Trust

General training in obstetrics and gynaecology followed by sub-specialty training in maternal and fetal medicine. He led a team providing tertiary level service for maternal medical problems and fetal problems, and established a service for managing neurological problems in pregnancy.

The late Javed Iqbal BSc MSc(Hons) FRCPath FRCP

Consultant in Biochemical Medicine

Javed Iqbal qualified with commendation from the University of Dundee Medical School. Whilst a Senior Registrar at the Royal Liverpool University Hospital he developed an in interest in metabolic bone disease which continued to be the main area of his clinical and laboratory practise. He had a special interest in clinical aspects of disorders of Vitamin D metabolism.

Manjiri Khare MRCOG MD FCPS DNB, Diploma in Obstetric Ultrasound

Consultant in Maternal-Fetal Medicine at the University Hospitals of Leicester NHS Trust

Manjiri has completed subspecialty training in maternal-fetal medicine in Leicester after training in obstetrics and gynaecology as a South East Thames trainee. She is the lead clinician for maternal-fetal medicine and Training Programme Director for the maternal-fetal medicine subspecialty programme in Leicester. She has special interests in managing multiple pregnancies, high-risk mothers with medical problems, infection in pregnancy and prenatal diagnosis. She is passionate about teaching and is a faculty member on the MRCOG course in Leicester. She is a co-convenor for the basic practical skills course in obstetrics and gynaecology in Leicester. She is a regional ultrasound training co-ordinator and runs the theory and hands on ultrasound course. She teaches midwifery students at the De Montfort University. She has contributed to substantive textbooks in her field. She has several publications in peer-reviewed journals and has been invited as international faculty for fetal medicine workshops, panel discussions and lectures.

Renuka Lazarus MBBS MD MRCPsych

Consultant Liaison Psychiatrist and Clinical Lead for Perinatal Psychiatry at the University Hospitals of Leicester NHS Trust

After training in the Charing Cross rotation in London, Dr Lazarus completed her higher training in psychiatry in Leicester. She took up her consultant post in liaison psychiatry in 2002. She is the clinical lead for the Perinatal Psychiatry Service in Leicestershire. She runs a weekly specialist perinatal psychiatry clinic based in the Antenatal Clinic at the Leicester Royal Infirmary; in-patient care is provided in a specialist mother and baby unit. She is involved in teaching medical and midwifery students and is a clinical supervisor for psychiatry trainees. She has organised training sessions for midwives and obstetricians. She is actively involved in research and audit. She is on the Expert Advisory Committee for the East Midlands Perinatal Psychiatry Clinical Network.

Christina Oppenheimer MA MB BS, FRCS, FRCOG

Consultant in Obstetrics and Gynaecology, Head of Service for Obstetrics at the University Hospitals of Leicester and Honorary Senior Lecturer in Medical Education

Christina qualified from Cambridge and London and pursued a broad-based surgical background prior to settling in obstetrics and gynaecology. Her particular interests are in obstetric haematology, hands-on high-risk intrapartum care with emphasis on multiprofessional care and training, paediatric gynaecology and pastoral aspects of medical education. She has published in both obstetric haematology and using qualitative research techniques in obstetrics. Team-working and multidisciplinary care is a particular passion.

Sue Pavord MB ChB, FRCP, FRCPath

Consultant Haematologist and Honorary Senior Lecturer in Medical Education at the University Hospitals of Leicester NHS Trust

Sue was appointed to this post in 1998. Her specialist clinical interests are obstetric haematology and haemostasis and thrombosis. In collaboration with obstetricians and specialist nurses, she established and has continued to develop a comprehensive obstetric haematology service with a heavy throughput of patients. She also runs a large Haemostasis Thrombosis Unit and is Haemophilia Comprehensive Care Centre Director. She is co-founder of the national Obstetric Haematology Group and established a postgraduate certificate course for health care workers in the field of obstetric haematology.

Paul Moran BM BS BMedSci MRCOG MD

Consultant in Obstetrics and Fetal Medicine at the Royal Victoria Infirmary, Newcastle upon Tyne

Paul graduated from Nottingham in 1989. He trained in Nottingham and the Northern Deanery and became a consultant in Newcastle in 2001. On appointment he introduced clinics for vulnerable women including those with substance misuse and mental health problems. He is lead clinician for fetal medicine with particular interest in fetal surgery, echocardiography and 4D ultrasound. Keen to promote more widespread understanding of pregnancy and fetal development he has contributed to books for a general readership and most recently edited The Pregnant Body Book.

Marie C. Smith MBBS MRCOG MD

Consultant Obstetrician at the Royal Victoria Infirmary, Newcastle upon Tyne and Senior Lecturer, Newcastle University

Marie graduated from Newcastle and completed obstetrics and gynaecology training in Nottingham, London and the Northern Deanery. She joined the Newcastle consultant maternal medicine team in 2008, and is the lead obstetrician in the Connective Tissue Disease clinic. Her current research interest is pre-term labour, in particular, the role of inflammatory signalling pathways in cervical remodelling.

Karen Watkins MB ChB(Hons) MRCOG

Lead Obstetrician for Intrapartum Care and Maternal Medicine at The Royal Cornwall Hospital, Truro

Karen graduated in 1993 with honours. She completed her basic training in Obstetrics and Gynaecology then in 1998 she became Clinical Research Fellow for the Magpie Trial investigating magnesium sulphate and its role in preventing eclampsia. Karen then worked for a number of years in Australia and during this time was awarded ‘Best of Free Communications’ at the RANZCOG Annual Scientific Meeting, June 2000 for research she had undertaken whilst in Australia. Karen completed the RCOG Maternal Medicine Module in May 2005 and spent a further year gaining additional training in maternal and fetal medicine.

Sophia Webster BMedSci(Hons) BMBS DFFP MRCOG

Obstetric Registrar at the Royal Victoria Infirmary, Newcastle upon Tyne

After qualifying from the University of Nottingham Medical School, Sophia began her obstetric training in London where her interest in high-risk obstetrics began to develop. This led her to spend 12 months in Cape Town, South Africa, before returning to the North East of England to complete her specialist training.

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