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Original research
Development of obstetric-hepatology services: defining optimal care and impact of pregnancy counselling on patient experience
  1. Mussarat Nazia Rahim1,
  2. Catherine Hedley2,
  3. Alex Frick2,
  4. Yooyun Chung1,
  5. Leonie Penna2,
  6. Lisa Long2,
  7. Catherine Williamson3,
  8. Michael A Heneghan1
  1. 1Institute of Liver Studies, King's College Hospital, London, UK
  2. 2Department of Obstetrics, King’s College Hospital, London, UK
  3. 3Division of Women’s Health, King’s College London, London, UK
  1. Correspondence to Dr Michael A Heneghan, King's College Hospital, London, UK; michael.heneghan{at}nhs.net

Abstract

Objective Prepregnancy counselling (PPC) is an important aspect of care for women with chronic liver disease (CLD) and liver transplantation (LT), yet its impact has not been well described. This study aims to assess the experience of women attending a joint obstetric-hepatology PPC clinic in a single-centre unit.

Design/methods A retrospective questionnaire-based study in a tertiary unit within the UK where patients who attended the PPC clinic between March 2016 and July 2021 were invited to participate by filling in a questionnaire. Descriptive data and free-text content were subsequently analysed.

Results 108 women attended the PPC clinic over a 5-year period. Overall, 58/108 (54%) completed the questionnaire. Principal concerns regarding pregnancy included fears around deterioration in health (66%), maternal death (24%), pregnancy loss (66%), medication effects (60%) and disease transmission (36%). 17/58 (14%) patients felt the presence of multiple doctors was intimidating, however, perceptions improved by the end of the consultation.

Overall, 44/58 (76%) respondents felt the clinic helped them reach a decision about pursuing pregnancy. Almost all respondents would recommend the clinic to others. There were no major differences in pregnancy outcomes between those that received PPC and those that did not.

Conclusion The PPC clinic facilitates a personalised approach to care and is well received by patients with CLD/LT. It is difficult to elucidate whether attendance alone impacts on pregnancy outcomes; registry data may be better placed at addressing this important question.

  • CHRONIC LIVER DISEASE
  • LIVER DISEASE IN PREGNANCY
  • LIVER TRANSPLANTATION
  • LIVER CIRRHOSIS

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. The data that support the findings of this study are available from the corresponding author, MAH, upon reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. The data that support the findings of this study are available from the corresponding author, MAH, upon reasonable request.

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Footnotes

  • Twitter @MussaratRahim

  • Contributors MNR: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript and statistical analysis. CH: study concept and design, acquisition of data, review of manuscript. AF: study concept and design, acquisition of data, review of manuscript. YC: manuscript editing and drafting, review of manuscript. LP: study supervision and review of manuscript. LL: study supervision and review of manuscript. CW: study supervision and review of manuscript. MAH: study concept and design, study supervision, critical revision of the manuscript, final review of manuscript and guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.