Outcome of high-risk pregnancies in a community health centre

The REACH community health centre in the east end of Vancouver serves a socially disadvantaged community of diverse ethnic origins. Nurse-practitioner and family physician teams provide antenatal care with appropriate support from nutritionist and clinical pharmacist. Well-baby care and developmental assessment are primarily carried out by the nurse-practitioners. Most infants are born at a family-centred hospital obstetrical unit. We reviewed 85 high risk pregnancies receiving prenatal care at REACH Centre and delivering between January 1976-January 1978. Obstetric outcome was comparable to other reports, in spite of a high-risk population. Anesthetic and analgesic use were lower than other reports. Fifty-two of the children were assessed by physical examination and Denver Developmental Screening Testing between 12-30 months of age. No previously unrecognized abnormalities were discovered. Fifty-one of them were functioning appropriately for age, and one child demonstrated marked speech delay. Immunization status was complete in 48/52 children (92%). This study suggests that high-risk pregnancies can be managed effectively in a family practice setting.