Duke Health Referring Physicians


High-Risk Obstetrics Clinic Increases Access for Patients Needing Complex Care

Pregnant woman

Duke OB/GYN’s Division of Maternal-Fetal Medicine (MFM) has recently expanded services at its multispecialty High-Risk Obstetrics Clinic for patients with high-risk pregnancies, adding a dedicated nurse navigator to coordinate complex maternal care.

The goals of this groundbreaking model are to improve the quality of care available, provide convenient access for Duke’s high-risk obstetrics patients, and decrease health disparities among this patient population.

“Many of our most significantly ill patients experience a lot of social determinants of health that can affect their care,” says Brenna Hughes, MD, MSc, the MFM division chief. “By having a dedicated care navigator, we hope to level out the field for those with significant medical problems and other complex social factors, so we can ensure they receive top-notch care during and after their pregnancy.”

The new complex maternal care coordinator, Dana McComb, RN, focuses on caring for mothers with significant cardiac disease, a history of transplant, or other rare, complicated diseases. Her expertise complements the team of specialty nurses who care for patients who need fetal surgeries or have fetal cardiac disease.

“At Duke, we are able to provide more patient-centered, team-based, multidisciplinary care and ensure that our patients with complex conditions have access to any medical specialists they might need,” Hughes adds.

The multispecialty clinic includes endocrinologists, who collaborate with the MFM division in the management of pre-gestational diabetes and complex endocrine disorders; cardiologists, who help treat maternal cardiac disorders; and anesthesiologists, who assist with complex deliveries. Care may also be provided by registered dietitians, diabetes nurse educators, and clinical social workers.

“Our integration of subspecialty care and consultation for the multidisciplinary care of pregnant women allows women with complex medical problems to get through pregnancy in a convenient and safe way,” notes Andra James, MD, MPH, MFM specialist and hematologist.

One such complex problem treated at the Duke High-Risk Obstetrics Clinic is placenta accreta, a disorder in which the placenta attaches abnormally to the uterus or other structures; placenta accrete is a significant cause of maternal morbidity and mortality around the world. Duke’s highly specialized Placenta Accreta Spectrum Program, led by MFM specialist Jennifer B. Gilner, MD, PhD, has become a regional referral center for this condition.

“Most patients have not heard about this condition until it impacts them, but a pregnant person who has had a cesarean delivery, placenta previa, or prior uterine surgery is at risk,” Hughes explains. “Our team’s unique approach to handling these cases has resulted in really spectacular outcomes for our patients.”