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As one of the largest providers of maternity services in London, we support mothers throughout their fertility journey from pre-conception through to postnatal care. Our team of world-renowned specialists work as one multi-disciplinary team across Royal Brompton, St Thomas’ and Evelina London Children’s hospitals, ensuring the highest standard of care for both mothers and babies. Consultant obstetrician Dr Spyros Bakalis and consultant cardiologist Dr Isma Rafiq share their expert insight into caring for mothers and babies with complex needs.
Identifying high risk pregnancies
50% of pregnancies will be categorised as high-risk, and risk factors can drastically change throughout pregnancy. Regular appointments, antenatal tests and pregnancy scans can support the diagnosis of conditions that make a pregnancy high risk early on, such pre-eclampsia, hypertension and gestational diabetes, allowing the appropriate care to be provided to both mother and baby.
Some conditions are difficult to identify because symptoms mimic typical pregnancy changes. For example, palpitations, unusual breathlessness, and a decrease in exercise tolerance may signal a heart condition, not just pregnancy side effects.
Dr Rafiq is the lead cardiologist of our high-risk cardiac obstetric service at Royal Brompton. She specialises in managing the care of pregnant women with heart conditions and emphasises the importance of a tailored approach, as these conditions can present in different ways.
“Each mother is different, even with the same diagnosis. We need to have personalised, tailor-made care for each mother, and that’s why my specialty is very unique, and what we offer is very unique, for the mothers and their babies,” notes Dr Rafiq.
Dr Bakalis, a consultant obstetrician, works closely with specialist services like Dr Rafiq’s to provide expert care to women throughout pregnancy, especially in high-risk cases. He discusses how he categorises such cases.
“The term ‘high-risk’ can be misleading. There is a spectrum of severity,” explains Dr Bakalis. “For example, someone with controlled hypothyroidism and another person with severe cardiac disease are both classified as high-risk, but the implications are very different.”
Pregnancy and congenital heart disease
As pregnancy puts extra stress on the heart, we offer a pre-conception heart check for women who are planning to have a baby. Depending on the patient’s needs, we will perform an echocardiogram (echo) or electrocardiogram (ECG) to help diagnose undetected conditions and potential risks.
If a condition or risk is detected early, mothers can work with a specialist to manage symptoms before, during and after a high-risk pregnancy. If a woman has a heart condition, such as arrhythmia, congenital heart disease, cardiomyopathy or mitral stenosis, our specialists can refer them back into our cardiology service, so they continue to receive care and have their condition monitored.
If a woman has a known cardiac history, it’s essential she receives pre-conception counselling before trying for a baby. Not all mothers adapt well to the physiological changes of pregnancy and are prone to adverse conditions such as arrhythmia, premature labour, gestational diabetes, preeclampsia or high blood pressure.
During pre-conception counselling, one of our consultant cardiologists will assess the woman’s medical history, evaluate the risks of pregnancy and determine the potential impact on both mother and baby. Depending on the class of the mother’s heart failure, care levels may vary. The European Society of Cardiology (ESC) advises that mothers with class 4 heart failure should not fall pregnant, however, attending a consultation with our specialists allows the mother to discuss options and have her condition reviewed.
If either parent has a congenital condition, there is a 3% to 5% chance the baby could inherit a congenital heart disease. For parents with Marfan syndrome, this risk increases to 50%.
Some of the most common congenital heart diseases include:
- bicuspid aortic valve
- pulmonary valve stenosis
- septal defects
- transposition of great arteries
If a parent is genotype-positive, we can refer them for preimplantation genetic testing (PGT) as part of our fertility service. Through IVF, embryos are tested to ensure they do not carry the mutation before implantation, minimising the chance of the gene being inherited and reducing some risks of the pregnancy.
“The next generation needs to be aware of genetic testing, especially if they have known cardiac conditions, so they can make an informed choice about their child’s future,” advises Dr Rafiq.
In cases where congenital heart conditions aren’t preventable, our consultant fetal cardiologists have developed a world-leading imaging programme to help diagnose them prenatally. Using 3D MRI technology from 18 to 20 weeks of pregnancy, we can assess the baby’s condition and ensure they receive timely and appropriate care.
A multidisciplinary approach to pregnancy
At Guy’s and St Thomas’ Specialist Care, mothers have regular appointments with a consultant obstetrician. If the pregnancy is high-risk, a specialist with expertise in the mother or baby’s specific condition will be present, so they can advise on next steps and answer any concerns or queries directly. This ensures that our patients receive high-quality cohesive care and can be treated in close proximity after birth.
Each element of care is closely monitored by our experts who understand the mother’s medical history, from midwives and anaesthetists to neonatal and mental health specialists.
“At St Thomas’, we work closely with cardiologists at Royal Brompton, as well as having clinics with rheumatologists and renal physicians,” explains Dr Bakalis. “When a fetus is diagnosed with a complex condition, we involve paediatric subspecialists before birth to prepare for postnatal care. This collaborative model significantly improves outcomes.”
A study found that over 68% of cardiovascular-related maternal mortality could have been avoided with multidisciplinary care. This approach not only improves outcomes but also helps mothers and their partners make informed decisions. We believe pregnancy should be an enjoyable experience, which is why our experts are dedicated to mothers and babies being able to receive care together.
“It’s reassuring for the mother to have seen a cardiologist early on, with any cardiac issues addressed and questions answered. When planning delivery, we involve an anaesthetist to discuss options like epidurals, delivery methods, and special considerations, such as managing a pacemaker,” explains Dr Rafiq. “These team discussions ensure everyone is prepared, and the mother feels supported.”
Managing high-risk pregnancies, especially those involving cardiac conditions, requires specialist input across specialties, proactive planning, and clear communication. At Guy’s and St Thomas’ Specialist Care, our world-renowned team is dedicated to supporting mothers through every stage of this journey, ensuring the safest outcomes for both mother and baby.
Dr Spyros Bakalis is a consultant obstetrician and subspecialist in maternal and fetal medicine. He has expertise in high-risk pregnancies and in the assessment and treatment of unborn babies. He is committed to the highest safety standards for both mother and baby, supporting women’s choices throughout pregnancy and childbirth.
Dr Isma Rafiq is a consultant cardiologist and the lead for high-risk pregnancy heart disease at Royal Brompton Hospital. She has expertise in several areas, including adult congenital heart disease, Fontan circulation, and preconception counselling. She also has extensive experience managing heart failure patients
When to refer
A patient can be referred to us as soon as they become aware of their pregnancy. If a patient has a health condition that could impact their pregnancy, they should be referred as early as possible. Certain tests, such as those for sickle cell and thalassaemia, should ideally be completed before 10 weeks of pregnancy.
If a woman has a health condition such as congenital heart disease, she can be referred for a pre-conception heart check. In some cases, preimplantation genetic testing may also be advised to ensure her condition is effectively managed before conception. Patients can self-refer to our services by booking an appointment with our customer services team.
Get in touch
For more information on our maternity services, preimplantation genetic testing (PGT) or pre-conception heart checks, please contact our customer services team. Call 020 3131 5130 or email gstt.PrivatePatientEnquiries@nhs.net