Background of Academic O & G at Chelsea and Westminster

Annual Births at Chelsea and Westminster

The delivery rate at the Chelsea and Westminster Hospital has more than doubled since it opened in 1994.

This has been driven by the activity of members of the academic department. For example, the diabetic pregnancy service was originally set up by Professor Steer and Dr David Leslie (now Professor at Barts/The London). It is now run jointly by Mr Mark Johnson and Mr Martin Lupton. Mr Johnson was a senior lecturer in obstetric medicine, having been accredited in general medicine, diabetes and endocrinology. He retrained in obstetrics and gynaecology and is now the only dually accredited obstetric physician/obstetric consultant in the UK. He has an honorary senior lectureship with Imperial College. Mr Martin Lupton was recently appointed as an obstetric consultant in high risk pregnancy and maternal medicine, with four sessions allocated (three paid for by Imperial College) to developing undergraduate teaching. The service now deals with over 50 insulin-dependent diabetics per annum, and approximately 75 new (gestational) diabetics are diagnosed and managed each year. This is one of the largest pregnancy diabetic services in London.

The Hypertension In Pregnancy Service

Set up by Professor Phil Steer in 1995, this service developed with the aid of research fellows Nick Anim-Nyame and Lucy Chappell. It formed the basis for prospective cohort studies of hypertension and preeclampsia in pregnancy, which have now resulted in almost 20 papers, including publications in the Lancet and the BMJ. This service was consolidated by Dr David Williams, a full-time obstetric physician, and following his departure to University College London, this work will be continued by Mr Johnson and Mr Lupton. Each year, almost 200 women with hypertension, 70 women with renal dysfunction, and 30 women with established renal disease are assessed and monitored in this clinic.

The Cardiac Disease In Pregnancy Service

Set up by Professor Phil Steer and Dr (later Professor) Jane Somerville from the Royal Brompton hospital and the National heart and Lung Institute in 1994, this service has developed subsequently in conjunction with Dr Sarah Thorne (who now heads a similar service at the Birmingham maternity hospital) and since 1999, with Dr Michael Gatzoulis (honorary Reader at Imperial College). Including women with both congenital and acquired heart disease, we are now delivering on average two such high risk cases every week.

This is an important service, because the latest Confidential Inquiry into Maternal Death in the United Kingdom (published in October 2004, covering the years 2000 - 2002 inclusive) shows that cardiac disease is now the most important cause of maternal death after suicide, with the mortality rate from this condition having risen substantially over the last 20 years. Surgery in childhood is increasingly able of to allow women with congenital heart disease (at almost 1%, the most common single congenital abnormality) to survive into the reproductive years. The Chelsea and Westminster hospital, in conjunction with the Royal Brompton hospital, has become a national centre for the management of these high risk cases, and in relation to pulmonary hypertension, has been recognised as such by the Department of Health.

We are increasingly researching into this area and are beginning to publish reviews and case series. We have set up a charity (BUMP - better understanding of mothers in pregnancy – see leaflet) which is now successfully fundraising to support our research into cardiovascular changes in pregnancy, and we have agreed plans to appoint two subspecialty training fellows/research fellows in this area later this year. We have already made grant applications and will be increasing our application rate in this area over the next two years. This development also includes collaboration with St Mary's (TG Teoh and Lorna Phelan) and Queen Charlotte's (Cathy Nelson-Piercy).

The High Risk Pregnancy Service

The Chelsea and Westminster unit is recognised to have one of the most developed high risk pregnancy services in the UK. The structure of the unit is shown in the appendix. The service includes two subspecialty trained fetal medicine consultants.

Perinatology
Since 2000, there has been a major clinical and academic investment in the development of perinatal medicine, including importantly the neonatal unit. The first stage was a substantial expansion of the obstetric facilities, which included the provision of two (rather than one) dedicated obstetric operating theatres, and a high dependency unit for women with medical disorders. The second stage included a complete rebuild of the neonatal unit to enable it to expand from its previous capacity of 23 cots, to 34 cots. The unit has currently reached 27 cots in terms of day-to-day capacity, but the number of intensive care cots properly funded and equipped has already risen from six to 10. The regional perinatal network has formally recognised the Chelsea and Westminster as one of the two major perinatal centres (including the Winnicott baby unit at St Mary's) for the North West Thames region. The Chelsea and Westminster is also recognised as the primary site for neonatal surgery within the network. In parallel with this has gone an increase in consultant staffing, and the sixth neonatal consultant post has just been appointed.

An important development has been the transfer of Dr Neena Modi from Queen Charlotte's to the Chelsea and Westminster, and her promotion to Professor of neonatal medicine. She is continuing the expansion and development of the research programme, including research fellows, which had already begun.

Ms Zoe Penn leads on the management of HIV disease in pregnancy, joint with Professor Gazzard’s Department of HIV Medicine and Professor Gotch’s Department Of Immunology.

Gynaecology

The Assisted Conception Unit

Set up in the early 1990s by Mr Mark Johnson and Mr Sam Abdulla (then a lecturer in the academic department, now the director of the Lister hospital assisted conception service, one of the foremost private units in London), the unit is now directed by Dr Carol Gilling Smith, assisted by Mr Julian Norman-Taylor. It undertakes approximately 400 cycles of assisted conception per year, and is a world leading centre for the treatment of HIV-positive couples. A full range of services is provided, including ICSI. The unit is strongly research active (see appendix of publications).

Reproductive Endocrinology

Established by Professor JWW Studd in the early 1990s, this service is a world leader in the area of the study and treatment of the menopause and the premenstrual syndrome. Apart from providing a very large clinical service, this group has always been strongly research active and has published extensively. A subspecialty training programme was recognised by the Royal College in 1997, and the second trainee is currently in post. Professor Studd retired in March 2005, and his lead role has been taken over by Mr Nick Panay, who runs the service jointly with his clinics at the Hammersmith Hospital.

Other gynaecological services

Other subspecialties well established at the Chelsea and Westminster include minimal access surgery, projected to be the regional specialist centre for the care of women with endometriosis (set up by Professor Christopher Sutton, and now headed by Mr Rick Richardson), urodynamics (Mr Mike Stafford) and oncology/major pelvic surgery (Mr Richard Smith, who has sessions at the Hammersmith Hospital, and Miss Jane Bridges, who has sessions at the Royal Marsden). The oncology service is now provided jointly with the Royal Marsden Hospital.

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