The report on Confidential Enquiries into Maternal Deaths (CEMD) in th
e United Kingdom (and previously England and Wales) is published every
three years (HMSO, 1991, 1994). In addition to presentation of cases
and statistics, a series of recommendations is made. Consecutive repor
ts have identified the need for multidisciplinary teams to decide mana
gement of high risk obstetric patients, and for early identification,
consultation and planning between obstetricians and anaesthetists for
these patients. A recent review of medical complications in pregnancy
highlights the need for modified antenatal care and a 'team approach'
for such patients (Maresh, 1990), but makes no attempt to suggest how
this can be achieved. Our maternity unit has developed a structured sy
stem for identifying antenatal patients with medical or anaesthetic pr
oblems that may constitute additional risks to their pregnancy or deli
very. These women are then seen in a multidisciplinary antenatal clini
c by the obstetric anaesthetist and an obstetrician, and a physician w
hen appropriate. This review of high risk pregnancy does not aim to be
completely comprehensive, but discusses some of the most commonly see
n problems in one UK teaching hospital maternity unit.