Screening/Diagnosis:         Pregnant women who deliver at 40+years of age are at an increased risk for poor pregnancy outcome often associated with chronic disease such as hypertension or diabetes.  In the absence of chronic disease these women are also at increased risk for stillborn infants.

 

 

 

 

 

 

 

If a patient has no comorbidities or fetal abnormalities she may remain at a community clinic.    If she is normotensive, but has a history of hypertension, she should have some evaluation of renal function (e.g. a 24 hour urine for protein and creatinine.)

 

If a patient develops hypertension, gestational diabetes, preterm labor, or fetal growth restriction she should be referred to the high risk clinic as soon as possible.

 

 

 

 

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.