Yang Huang Grace Ng, Ann Wright, Yvonne Yee Voon Ng, Nirmal Visruthan Kavalloor, Lay Kok Tan, Bin Huey Quek, Kok Hian Tan
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While this model of care delivery is increasingly adopted worldwide, data on the prevalence and patterns within such multidisciplinary services remains limited.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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. 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引用次数: 0
摘要
高危妊娠的管理需要跨多个专业协调的专业知识。高危咨询（HRC）汇集了一个多学科专家团队，包括母胎医学专家、新生儿专家、麻醉师和相关亚专科，为这些复杂的妊娠提供全面、个性化的护理。虽然这种提供保健服务的模式在世界范围内越来越多地被采用，但关于这种多学科服务的流行程度和模式的数据仍然有限。目的：描述由HRC管理的高危产前病例的类型，并比较这些情况在两个不同时期的患病率。方法：本回顾性观察性研究分析了新加坡KK妇女儿童医院（KKH）的HRC中讨论的所有病例。收集了两个时期的数据：1994-2003年和2008-2021年。结果：1994 - 2003年共2356例（合并4097例），2008 - 2021年共2514例（合并5944例）。这些病例占KKH各自时期151,589例分娩的1.51%和162,017例分娩的1.55%。尽管随着时间的推移，年分娩率总体下降，但高危病例的比例保持稳定。然而，具体情况的患病率发生了显著变化。胎膜早破（17.6% vs 9.6%）、先兆子痫（10% vs 4.8%）、早产（12.6% vs 2.9%）发生率下降（均p < 0.0001），胎儿异常发生率明显升高(1.6% vs 14.5%；P < 0.0001)。结论：在这两个时期，需要HRC咨询的妊娠总比例保持一致，约为1.5%，但病例构成发生了显著变化。这些发现突出了多学科护理的发展重点，并为三级产科单位的资源分配和服务规划提供了信息。试验注册：CIRB编号：2022/2458。
High-Risk Consult Multidisciplinary Team in a Tertiary Maternity Unit: Changing Prevalence of Cases.
Introduction: 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.
Objective: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
期刊介绍：
The Journal of Multidisciplinary Healthcare (JMDH) aims to represent and publish research in healthcare areas delivered by practitioners of different disciplines. This includes studies and reviews conducted by multidisciplinary teams as well as research which evaluates or reports the results or conduct of such teams or healthcare processes in general. The journal covers a very wide range of areas and we welcome submissions from practitioners at all levels and from all over the world. Good healthcare is not bounded by person, place or time and the journal aims to reflect this. The JMDH is published as an open-access journal to allow this wide range of practical, patient relevant research to be immediately available to practitioners who can access and use it immediately upon publication.
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