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Collaborative Care for High-Risk Pregnancies

Pregnancy can be a joyous time for expectant mothers, but it can also be stressful if health risks arise. Since 2014, Cedars-Sinai’s multidisciplinary High-Risk Perinatal Program has offered coordinated, specialized services to care for patients with high-risk pregnancies or those whose fetus shows signs of abnormality or a congenital problem. 

The full-service High-Risk Perinatal Program provides personalized, multidisciplinary care matched to the specific needs of pregnant patients and their babies. The program offers 24-hour access to board-certified maternal-fetal medicine physicians and neonatologists (high-risk neonatal doctors) for consults and transfers, and additional specialists are available as needed for scheduled consults. 

The program is led by co-directors Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology and the Helping Hand of Los Angeles Chair in Obstetrics and Gynecology at Cedars-Sinai; and Kurlen Payton, MD, associate director of the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s. Our team aims to simplify the referral process and co-management of care when this program’s specialized expertise is required.

Collaboration Throughout the Patient Journey

Collaboration and accessibility are at the heart of the program. High-Risk Perinatal Program Coordinator Tracy Carter, RN, ensures regular communication between all specialists, the referring physician and the patient.

When a patient is referred, Carter contacts the patient to discuss the family’s specific needs. Carter, who has spent nearly her entire career working with high-risk pregnancies, is a constant primary point of contact for the patient throughout her entire pregnancy journey, handling everything from questions and concerns to appointment logistics.

“I know that health risks during pregnancy can be traumatic,” said Carter. “By their first appointment, our patients know they are not going through this pregnancy alone. It’s more than coordinating care—you are giving a piece of yourself to the patient. I try to alleviate some of their burden.”

During the initial appointment, patients are assessed, and a multidisciplinary team of physicians is assembled to match their unique needs. The team focuses on improving outcomes using a thorough risk assessment that leads to mitigation and management strategies for identified symptoms or complications. The team also evaluates whether the mother needs to deliver at Cedars-Sinai or if we can just help with managing prenatal care to allow for a safe delivery at her home hospital. Of course, our ultimate goal is for the mother to have a safe full-term pregnancy and delivery.

Every patient’s care plan is evaluated weekly at a multidisciplinary meeting to ensure total coordination of care. The collaborative meeting includes maternal-fetal medicine physicians, neonatologists, pediatric and adult cardiologists, pediatric surgeons, obstetric anesthesiologists, labor and delivery and neonatal nurses, and other subspecialists, as needed. These discussions can also include the patient’s primary obstetrician or provider. 

“The program is all about being careful, planning collaboratively and having dedicated specialists available,” said Kilpatrick. “We see patients with complex problems that require a higher level of specialized services, which we can provide all in one place at Cedars-Sinai. We strongly feel that to provide the best care for these women, we must have all these pieces available in one hospital when they need it.”

Partnership with Referring Physicians

The Cedars-Sinai team believes accessibility is key for both patients and their referring physicians, as quick access to care is critical when dealing with complex pregnancies. Physicians also have 24-hour access to specialists within the program—meaning they can call any time and reach the maternal-fetal medicine attending physician or the neonatal attending physician directly. 

Timely, detailed updates are also considered crucial. When a patient has a consult with the Cedars-Sinai team, the referring physician receives information following the visit. Kilpatrick and her team know how important it is for patients to have local support and remain in their communities when possible, especially when they live far from Cedars-Sinai.

“We know it can be overwhelming for patients to come to Cedars-Sinai and see a new care team, and we want to make them feel comfortable during this transition,” Kilpatrick said. “We don’t want to take them from their home hospitals, though the most severe often need to deliver with us. In that case, we keep clear and consistent communication with the referring physicians and provide updates throughout the process.”

The High-Risk Perinatal Program has taken care of many patients beyond the immediate Los Angeles region. The team aims to minimize logistical concerns and barriers through the use of video visits, in-person appointment clustering and close coordination with local providers.

Improving Outcomes: More to Come

Since its inception, Cedars-Sinai’s High-Risk Perinatal Program has significantly increased maternal referrals for both those with fetal anomalies and those with complex maternal issues. Offering support for newborn, maternal and nursing issues, both mom and baby are cared for throughout the pregnancy and after delivery. In the future, Kilpatrick hopes to grow the program, help the community, and support women with very high-risk and complicated pregnancies.

“It is important that those of us who have both the background in this field and the resources step up and help these patients and their families,” Kilpatrick said. “Our responsibility is caring for the community around us, and we have the ability to do so at Cedars-Sinai. I see us doing even more of that in the future.”