High-Risk Obstetric Services

Our team has a special interest and adavanced credentials in high-risk pregnancies. There are many factors that can make a pregnancy high risk, including existing health conditions, your age, lifestyle, and health issues, including those that that happen before pregnancy but also some that happen during pregnancy.

Whereas the majority of high-risk pregnancies and births go without complication, in part that is because of the careful approaches and protocols adopted to ensure that the risk factors are appropriately addressed. It also means ensuring that you have just the right backup ready to be engaged if needed.

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Highly experienced, tertiary consultant, multidisciplinary team

All key staff live within 5 minutes of hospital

24/7 access for concerns or urgent care issues

What is a high-risk pregnancy?

Quite simply, it is any pregnancy where there is a greater than normal chance of complications for either Mum or the baby. There are many factors that can predispose a pregnancy to risk. The following is not designed to be fully comprehensive but certainly covers the main ones.

Existing Health Conditions

High blood pressure
Polycystic ovary syndrome (PCOS)
Diabetes
Kidney disease
Autoimmune disease
Thyroid disease
Obesity
Certain infections e.g. Zika

Life Decisions & Lifestyle

First pregnancy after age 35
Alcohol use
Tobacco use
Drug use

Conditions of Pregnancy

Multiple gestation
Gestational diabetes
Preeclampsia and eclampsia
Previous preterm birth

First Pregnancy after age 35

With busy lives and careers, this is perhaps one of the more common reasons for a pregnancy to be higher risk. Most pregnancies to older first-time mothers are normal but there are heightened risks of the following:

Pregnancy-related high blood pressure (called gestational hypertension)
Diabetes (called gestational diabetes)
Pregnancy loss
Ectopic pregnancy (when the embryo attaches itself outside the uterus)
Caesarean delivery
Delivery complications, such as excessive bleeding
Prolonged labour (lasting more than 20 hours), or labour that does not advance
Genetic disorders in the baby e.g. Downs Syndrome

Consequently, these are pregnancies and deliveries where we want to adopt a heightened vigilance and ensure there are plans in place to manage any specific risks.

Gestational Diabetes

Gestational diabetes is diabetes that is diagnosed for the first time during pregnancy. The good news is that it normally reverts after pregnancy. However, it can lead to sometimes serious complications during pregnancy and delivery and as such needs careful management and birth planning, with heightened coordination between obstetrician and neonatologist. Some of the complications include:

Excessive birth weight, requiring a caesarean section delivery
Early (preterm) birth, requiring baby to be admitted to NICU under a neonatologist
Serious breathing difficulties, requiring immediate attention from a neonatologist
Low blood sugar (hypoglycemia), sometimes requiring specific support for your baby
Obesity and type 2 diabetes later in life, for mum
Stillbirth, an occasional complication of poorly managed gestational diabetes

Gestational diabetes is very common in Cayman Islands, especially in mums of Caribbean origin. We will always monitor closely for it so that we can ensure it is managed well during pregnancy and plan birthing arrangements to ensure everything goes smoothly and safely.

Our High-Risk Pregnancy Service

Our Obstetric-Fetal-Neonatal team collectively represents decades of consultant-level, tertiary experience in managing both high risk pregnancies and the fetal or newborn complications that can arise. It is quite simple unique on Island:

Only combined Obstetric-Neonatal team, allowing a true, seamless, multidisciplinary approach
Only team with both obstetric and neonatal accredited and experienced tertiary consultants
Detailed fetal anomaly scans conducted by a highly experience sonographer and independently reported
All key obstetric and neonatal team members live within 5 minutes of Cayman Islands Hospital in George Town
24/7 access to the team for concerns or urgent care issues

Based on our combined experience of literally thousands of high-risk pregnancies, here and in the UK, our approach is comprehensive, designed to assess all risk factors, proactive and multidisciplinary. We’d be delighted to talk through that approach in detail, without charge, so that you can understand just why it is unique, as well as meet the team members who might be involved.

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Fetal Medicine for High Risk Pregnancies

Our fetal medicine service is designed to ensure that fetal and maternal health are optimally managed through pregnancy, especially where risks or concerns exist. It’s planned from pregnancy to pregnancy and involves pre-conception counselling for women with previous adverse pregnancy outcomes, care of women with fetal abnormalities and fetuses identified with growth restriction, monitoring of fetuses during pregnancy and liaising with neonatal team to plan and ensure appropriate timing and place of delivery.

Dr Madhavi Manoharan has advanced training in fetal medicine, accredited by the Royal College of Obstetricians and Gynaecologists in UK and more than a decade of consultant-level, tertiary experience.

Pregnancy Imaging

With the importance of scanning in identifying anomalies and concerns, we take a very comprehensive approach in order to successfully guide our care through pregnancy, birth and beyond. This means state of the art, 3D and 4D scanning by a specialist radiographer, which is then reported by specialist radiology and our own fetal medicine specialist, Dr Madhavi Manoharan. Concerns are then evaluated by our full team and care planned accordingly, all in full discussion with you.

Our equipment is some of the very best available and we have multiple 3D/4D ultrasound machines in-house.

What is Fetal-Maternal Medicine (and do I need it)?

These are obstetricians who have additional specialist training in helping women through high-risk pregnancies or complications. They are focused on achieving a safe delivery and outcome for both mother and baby when things aren’t straight forward.

We are so lucky to have one (Dr Madhavi Manoharan). It means you’ll have access to this advanced care automatically if you book your pregnancy with her and she’s right there to support her colleagues if a concern arises. Peace of mind comes as standard with our team.

Learn More: Explanation by Intermountain Health

Meet the High-Risk Pregnancy Team

If you are in any way concerned you may fall into a high-risk category, or have a family history of higher risk pregnancies or complications, we’d be delighted to meet you, completely without charge, either before conceiving or at any stage, so that we can discuss this with you and so that you are familiar with the team.

Dr Lisa Joels

Obstetrician & Gynaecologist
MB ChB, MD, FRCOG, FHEA
Tel: +1 (345) 745 7450 (clinic)
Email: [email protected]

Dr Madhavi Manoharan

Obstetrician & Gynaecologist
MBBS, MD, MRCOG
Tel: +1 (345) 745 7450 (clinic)
Email: [email protected]

Dr Sara Watkin

Specialist Paediatrician & Neonatologist
MB ChB, MRCP (paeds), FRCPCH, MD
+1 (345) 745 7450 (Clinic)
+1 (345) 326 7827 (Mob)
[email protected]

Dr Lisa Joels, is a highly experienced Obstetrician with over 34 years of experience, 19 of which at the level of consultant working in tertiary University hospitals caring for complex or high-risk pregnancies. Qualified in MOET (Managing Obstetric Emergencies & Trauma), she’ll support you throughout your pregnancy to ensure everything goes well and if nature throws in a hurdle, she has decades of experience to draw upon.

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Dr Manoharan has 23 years’ experience in obstetrics and gynaecology, including more than a decade at tertiary level, 7 years as consultant at the prestigious Royal Free London NHS Foundation Trust and a number of years as Assistant Professor at the world-renowned Weil Cornell Medicine, located in their Qatar campus, part of Cornell University, as well as a special interest & accredited advanced training in fetal-maternal medicine.

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Prior to moving to Grand Cayman, Sara was Chief of Service for the prestigious and renowned neonatal service at University College Hospitals London, caring for a complex mix newborn patients from the extremely preterm to those with complex genetic abnormalities. On Island, she has supported the very smallest patients and many of the most complex, including saving many lives in difficult circumstances.

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We will never share your details with any other party.

Team is Important

A successful outcome in a higher-risk pregnancy is a function of the right skills, expertise and experience when you need them most, focused on both Mum and Baby, with seamless communication and coordination between care professionals. Having that whole team in Integra means a true multidisciplinary approach to managing even the most difficult of pregnancies. Dr Joels, Dr Madhavi and Dr Watkin, collectively, have more than 50 years experience at consultant level in caring for Mum & Baby, earned in tertiary centres in the UK. That’s a unique combination devoted to your successful pregnancy.

Dr Lisa Joels

Obstetrician & Gynaecologist
MB ChB, MD, FRCOG, FHEA
Tel: +1 (345) 745 7450 (clinic)
Email: [email protected]

Dr Joels has 36 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20). She was lead clinician for prestigious Fertility Exeter and is passionate about women-centred care.