Feature articlesMarch 2024

New JGH clinic gives expectant mothers access to internists’ expertise

Obstetric Medicine Clinic helps ensure all bases are covered during pregnancy

As Amy Kasner’s pregnancy progressed, her obstetrician kept noticing that her blood pressure was creeping steadily upwards. Some escalation might not be abnormal, but her doctor concluded the hypertension was a cause for serious concern.

Guidance from a specialist was clearly required—and, as it happened, a new clinic for problems of this kind had recently opened at the JGH, just when Ms. Kasner needed it most.

With a referral from her obstetrician, she turned to the Obstetric Medicine Clinic, where expectant mothers with various medical conditions can benefit from the guidance of a general internist with expertise in obstetric medicine.

“Our goal is to work closely with the patient’s specialist in maternal-fetal medicine, or with her obstetrician, family physician or midwife,” says the clinic’s founder, Dr. Camille Simard, a specialist in general internal medicine in the Division of Internal Medicine.

“Together, we deal with the more complex medical problems that may exist before pregnancy or that might arise during pregnancy.”

“The important thing is to cover the patient from every angle and provide support to make the pregnancy and birth healthy and happy for the mom and her baby.”

For the 31-year-old Ms. Kasner, it was a relief to meet with Dr. Simard on three occasions in the month before her labour was induced and her daughter was born at the JGH in mid‑January. Her blood pressure was monitored, her medications adjusted and her general health checked to properly manage any potential risks.

“She’s great—really friendly and empathetic,” says Ms. Kasner of Dr. Simard. “I really felt reassured that I was being properly looked after. There were also times when I had to email her between appointments, because I was concerned about something, and she always got back to me quickly— usually on the same day—to tell me what to do.”

Patients with a wide range of medical conditions stand to benefit from the Obstetric Medicine Clinic, Dr. Simard explains.

For example, a woman who has lived with lupus and been on immuno-suppressants for most of her life might want to have a child. Dr. Simard meets with her before conception to plan a safe pregnancy, be certain the disease is being properly controlled, and ensure that the patient’s medications can be taken safely during pregnancy and breastfeeding.

Since blood clots can also occur during pregnancy and raise the risk for thrombosis, Dr. Simard provides the necessary counselling. If the mother-to-be is already on blood thinners to prevent a clot, Dr. Simard works with the obstetrician or other physician in the care team to safeguard the patient’s health and make epidural anesthesia possible during labour.

The Obstetric Medicine Clinic, where patients are seen by referral, was launched in the fall of 2023 in the Perinatal Centre on the third floor of Pavilion H. During its start-up period, it has been open once a week for half a day, but Dr. Simard hopes to add more hours if demand increases as word spreads about the clinic.

Similar clinics already exist in some other Quebec hospitals, including the CHU Sainte-Justine (where Dr. Simard trained) and at the McGill University Health Centre. So when a decision was made to have the JGH open its own Obstetric Medicine Clinic, Dr. Simard—who is also an Assistant Professor at McGill University—was the ideal person to lead the initiative.

Her residency at the JGH was followed by fellowships in obstetric medicine at Sainte-Justine and the Université de Montréal, followed by a fellowship in thrombosis medicine at the Ottawa Blood Disease Centre. This has given her what she describes as “deeper insight into some of the areas that may be more complicated to manage during pregnancy.”

Dr. Simard has been at the JGH since spring 2023 and, when not busy in the clinic, she sees patients with various internal medicine pathologies, including those who are at risk for or have had a thrombosis.

“I suppose you could say the Obstetric Medicine Clinic helps to make certain that all of the I’s are dotted and the T’s are crossed,” Dr. Simard says. “The important thing is to cover the patient from every angle and provide support to make the pregnancy and birth healthy and happy for the mom and her baby.”

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