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Specialty OB Clinics:

Improving Outcomes Through Customized Care

February 2014

The Department of Obstetrics and Gynecology offers a broad spectrum of health care options for expectant mothers including a number of specialty clinics. In 2013, about 4,500 women delivered their babies at Vanderbilt and several thousand utilized Vanderbilt’s prenatal services.

Fetal Center at Vanderbilt

The largest of these subspecialty clinics, it meets five days a week. It is directed by Kelly Bennett, M.D., director of the Division of Maternal Fetal Medicine.

Specialists help minimize risks to both mother and baby. The team of experts manage any problems that may occur during pregnancy. With advancements in fetal diagnosis and therapy, the center has seen improved outcomes of the fetus at risk.

The Fetal Center is located at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. Consultations by appropriate specialists are coordinated at a single site with Maternal Fetal Medicine, Pediatric Surgery, Neonatology, Pediatric Neurosurgery, Pediatric Cardiology, Pediatric Urology, Pediatric Plastic Surgery, Pediatric Otolaryngology, Genetics, and Diagnostic Imaging.

Obstetrics at the Comprehensive Care Clinic
(HIV/AIDS medical clinic)

Known as the OC3, this clinic began in 1999. More than 350 women have been seen at the clinic that combines OB and HIV care. Since its opening, more than 300 infants have been born to HIV-positive women. Only one of these infants has been HIV positive.

The statistics for rate of transmission for babies born under the care of clinicians at the OC3 are remarkable—less than 0.5 percent, which is below the national average of 2 percent.

Lavenia Carpenter, M.D., assistant professor of OB-GYN, points to the collaborative efforts established early on at the clinic. Studies have shown that the lowest rates of transmission are among the group of women who start medications early and maintain and adhere to the medication regime, she said.

The team consists of clinicians and case managers who follow both the mom and baby through pregnancy and the postpartum period. Staffing includes an HIV family nurse practitioner, Maternal Fetal Medicine faculty member, pediatric infectious disease clinical nurse specialist, social worker, medical case manager, nutritionist, mental health clinician and a pharmacy team member.

Nearly one-third of OC3 patients are newly diagnosed at the time of their pregnancy.

“Not only are these women finding out that they are pregnant, they are also finding out that they are HIV positive,” said Carpenter. “They are very grateful for our services because having the combined support in one place has been tremendously helpful for them. That is a major reason why this model of collaborative care has been so successful.”

Diabetes Clinic

The first specialty clinic established in the early 1970s at Vanderbilt, the Diabetes Clinic is the now run by Etoi Garrison, M.D., Ph.D., assistant professor of OB-GYN.

Designed to meet the unique needs of patients with type I and type 2 diabetes, the clinic delivers about 80 babies a year.

“As the rate of obesity rises within Tennessee and Nashville, we are seeing more patients with type 2 diabetes,” said Garrison. “We are seeing an increase in our population, and with the rise in the prevalence of obesity, I am looking ahead and seeing the need to expand our clinic.”

Coordinating care for pregnant women with diabetes allows clinicians to not only care for the mom but to also monitor the baby.

“For moms with diabetes, being pregnant can increase the risk that their diabetes can be more difficult to manage,” Garrison said.

Congenital Heart Disease Clinic for Pregnant Women

As babies born with congenital heart diseases reach adulthood, maternal fetal medicine practitioners are seeing a rise in the number of patients requiring specialized services.

In the past year, Carla Ransom, M.D., assistant professor of OB-GYN, and May Ling Mah, M.D., assistant professor of Pediatric Cardiology, have cared for nearly 100 patients with congenital heart disease (CHD). The volume of patients prompted the Medical Center to create a specialized clinic for pregnant CHD patients. It will open in March.

“This gives women a designated group of physicians who will care for them and who they can call on at any point in their pregnancy,” Ransom said. “Few centers in the country offer this service. It has been shown that the overall pregnancy care improves when there is communication between cardiology and maternal fetal medicine.”

Bariatric Obstetric Care Clinic

“There is a real need to decrease obstetric complications associated with obesity,” said J Michael Newton, M.D., Ph.D., Maternal Fetal medicine specialist, assistant professor of OB-GYN and director of the new center.“It is my hope that a specialty clinic aimed at a better understanding of these patients and a comprehensive approach to their care will improve outcomes.”

Nationwide, more than one-third of expectant moms are obese, which is characterized as having a total body mass index (BMI) above 30. Newton’s clinic is targeting women with a BMI over 50 or a BMI over 40 with co-morbidities like hypertension or diabetes.

Patients falling in the obese category are at increased risk for diabetes, hypertensive disorders, pre-term delivery, cesarean deliveries and complications with anesthesia.

The comprehensive clinic will have a perinatologist, nutritionist, psychologist and social worker as well as opportunities for patients to meet with an exercise physiologist and bariatric surgeon or experts in the Center for Medical Weight Loss.

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