High-Risk Consult Multidisciplinary Team in a Tertiary Maternity Unit: Changing Prevalence of Cases

The management of high-risk pregnancies requires coordinated expertise across multiple specialties. The High-Risk Consult (HRC) brings together a multidisciplinary team of specialists, including maternal-fetal medicine specialists, neonatologists, anaesthesiologists, and relevant subspecialities to provide comprehensive, individualized care for these complex pregnancies. While this model of care delivery is increasingly adopted worldwide, data on the prevalence and patterns within such multidisciplinary services remains limited.

To describe the types of high-risk antenatal cases managed by an HRC and compare the prevalence of these conditions across two distinct time periods.

This retrospective observational study analyzed all cases discussed at the HRC of a single tertiary center, KK Women's and Children's Hospital (KKH), in Singapore. Data were collected for two epochs: 1994-2003 and 2008-2021.

There were 2356 cases (with 4097 associated conditions) from 1994 to 2003 and 2514 cases (with 5944 conditions) from 2008 to 2021. These cases constituted 1.51% of 151,589 deliveries and 1.55% of 162,017 deliveries at KKH in the respective epochs. Despite an overall decrease in annual delivery rates over time, the proportion of high-risk cases remained stable. However, the prevalence of specific conditions changed significantly. The incidence of preterm rupture of membranes (17.6% vs 9.6%), preeclampsia (10% vs 4.8%), and preterm labor (12.6% vs 2.9%) decreased (all p < 0.0001), while fetal anomaly showed a marked increase (1.6% vs 14.5%; p < 0.0001).

The overall proportion of pregnancies requiring HRC consultation remained consistent at approximately 1.5% across both epochs, but there were notable shifts in the case composition. These findings highlight evolving priorities for multidisciplinary care and inform resource allocation and service planning in tertiary maternity units.

CIRB Ref: 2022/2458.