In May 2015, Guy’s and St Thomas’ NHS Trust launched a new service designed to improve the care of pregnant women with chronic hypertension. Chronic hypertension is hypertension (or high blood pressure) present before pregnancy. The condition is relatively rare, affecting around two per cent of pregnant women, but those with it are likely to experience more complex pregnancies, with greater risks of preterm birth, growth-restricted babies and complications, such as pre-eclampsia. The new service involves a dedicated team offering specialist support to around 120 women a year.
A new project adopted by CLAHRC South London in April 2016 will evaluate the implementation of the new service. The aim is to see whether this specialist care improves outcomes for the mother and baby, and ultimately, to inform the development of services for women with hypertension in pregnancy, both in south London and across the UK.
The project is being led by Professor Lucy Chappell, a professor of women's health at King's College London, member of CLAHRC South London’s maternity and women’s health team, and a consultant obstetrician at Guy’s and St Thomas’. Professor Chappell says that the first step for the project is to ‘identify what high-quality care for these women looks like.’
Key to this is ensuring that women with chronic hypertension are quickly identified and then referred to the service. ‘We will also be researching barriers to care. Why are women not taking up care offered by the service or why are they being referred late? This could, for example, be down to an individual health professional being reluctant to move away from previously established models of care,’ says Professor Chappell.
The success of the new service will be judged against a set of outcomes that will take in the way the service operates – such as referral rates and timing, and rates of non-attendance – and clinical outcomes, such as how many weeks pregnant the mother is when her baby is delivered, and complications for baby and mother around birth.
Much of the research on the project will be undertaken by a researcher-midwife doing a PhD drawing upon theories of implementation science, jointly supervised by Professor Jane Sandall and Professor Chappell. The project is expected to finish in 2020.