Spotlight on: Mark Andrews, Renal and Obstetric Physician

We have become home to one of two Maternal Medicines Centres in the East of England and at the helm of the service is Mark Andrews, Renal and Obstetric Physician.

As part of the national strategy to create these centres of excellence, NHS England funded the training of 12 consultant physicians in Obstetric Medicine. Mark had had experience of Obstetrics and “high risk pregnancy” as it was called, while a medical registrar in Nottingham.

Since that time, he has continued an interest within his own specialty of renal (kidney) disease and has long experience of the management of kidney disease in pregnancy. This experience meant he was an ideal candidate, and he became the first person to complete the year-long part-time programme at Guy’s and St Thomas’s Hospital and University College London Hospital. Mark remains the only person in the country to be awarded the prestigious Diploma in Obstetric Medicine.

Mark trained as doctor at The University of Birmingham, even doing one “pre-registration house job,” in surgery at the old hospital site. After a medical rotation in Leicester where he first became interested in Renal Medicine, he trained in Renal Medicine in Stoke-on-Trent, Wolverhampton and Nottingham before a first consultant post in Scotland before moving to Norwich in 2004.

“What this training does is to enable you to take a helicopter view of the pregnancy and the woman with one or more medical conditions potentially complicating pregnancy,” said Mark.

“It might be they have a condition and need advice on what impact pregnancy might have on their condition; could they have a baby, what impact would it have on their baby and the course of the pregnancy; is it safe even?

“Pregnant women can of course become acutely unwell at unpredictable times, for example, with severe asthma, or there may be a flare up with their rheumatoid arthritis or inflammatory bowel disease. How is this best managed?  This is one of the roles of the Obstetric Physician, working with specialty colleagues, anaesthetists and obstetricians to manage acute problems in pregnancy to ensure a safe delivery at the right time.”

Creation of the Regional Maternal Medicine Centres follows successive maternal death reports that showed the majority of women dying during or after pregnancy have pre-existing conditions exacerbated by pregnancy rather than due to the pregnancy itself. Expert review suggests that many of these deaths might have been avoided had the women been referred to a multi-disciplinary team with specific training and experience in medical diseases in pregnancy. The Ockenden report, which reviewed the unacceptably high number of maternal and neonatal deaths at Telford and Shrewsbury Trust, has further emphasised these concerns.

NHS England has an ambitious aim to reduce maternal deaths by 50% by 2025. Towards this goal, they have supported the establishment of a national Maternal Medicine Network with a ‘hub and spoke model’ in each region. With a long-standing established maternal medicine service, Norwich was in an ideal position to provide a regional networked service, which Mark is leading with the existing Maternal Medicine team led by Obstetric Consultant Fran Harlow.

“But it is not all about the fortunately rare deaths related to maternity, it is about the whole experience,” added Mark.

“It’s about the trauma of having poor blood pressure control and having a premature baby, the stress for mum, the family, her baby and strain on the NHS. If you have training such as this in Obstetric Medicine you can help avoid some of these apparently sudden problems and work with the team to keep mums safe and deliver their babies in a planned way at the best time for all.

“There are plenty of experts in kidney disease and people to deliver babies but there are very few able to look at the interface between the two with a real focus on the needs of the mum and her baby.

“I am thrilled to part of a fabulous team taking on the challenge of improving health and outcomes for those planning pregnancy as well as during pregnancy. Here we are fortunate to have colleagues with national and international reputations and huge expertise in dealing with serious issues in pregnancy such as diabetes, heart conditions and blood disorders. We were always going to be well placed to provide a regional service and I hope I can bring some extra skills to the team and provide a “helicopter view” when managing complex patients because I am looking at the interface between serious disease and pregnancy with a real focus on the needs of mum and her baby.”

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