title: Medically complex pregnancy: a case report illustrating CNM/MD collaborative management.
abstract: In contemporary society, many women with complex medical conditions are attempting fertility and becoming pregnant. The patient presents with an impressive medical complication, yet many of her key educational and psychosocial needs are typical of those for any pregnant woman. Striving for "normalcy," she may actively seek midwifery care to help her create a family-centered birth experience. Indeed, the midwife practicing with physician colleagues may have the opportunity to collaboratively manage increasingly complex cases. This article describes the case of collaborative management during pregnancy and delivery of a patient with the cardiac syndrome Wolff-Parkinson White syndrome (WPW). First diagnosed with WPW at the age of 13, the patient's condition was initially controlled with oral medication. Eventually, the patient's symptomology worsened and required repeated treatment by cardiac ablation of the accessory pathway. Illustrative of the possibilities for enhanced care of the medically complex pregnant patient via collaborative management, the discussion details not only the pertinent physiologic events but the benefits and process of care. A review of the cardiophysiology of WPW is also presented.
authors.affiliation: Wesson Women and Infants' Unit, Baystate Medical Center, Springfield, MA 01199, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gray
authors.forename: L
authors.initials: L
authors.lastname: D'Amato
mesh_terms: D000293:Adolescent; D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D010348:Patient Care Team; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000451:nursing / Q000628:therapy; D014927:Wolff-Parkinson-White Syndrome / Q000209:etiology / Q000451:nursing / Q000628:therapy