Medical Complications During Pregnancy

Who is qualified to care for pregnant women with coexisting medical disease? If you were to ask an obstetrician, the most likely answer would be those who practice maternal-fetal medicine, a subspecialty of obstetrics-gynecology that deals with maternal and fetal abnormalities during pregnancy. If you were to ask an internist, the most likely answer would be an internist, or perhaps an obstetrical internist—a new subspecialty of internal medicine. (The only two fellowships in obstetrical medicine in North America are at Brown University in Providence, RI, and McMaster University in Toronto, Canada.) In reality, the two disciplines complement each other; the maternal-fetal medicine specialists bring their understanding of the normal physiologic changes of pregnancy and the impact of maternal disease on fetal well-being to the discussion, and the internists bring their deeper understanding of the pathophysiology of chronic disease. Maximal patient benefit accrues when the patient finds herself in that area