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Care teams may hold the key to complex deliveries.

Medical practice has evolved, and will continue to do so, as we begin pushing for more personalized and better precision health care. Gone are the days of the general practitioner who attempted to treat all conditions in all patients. Health care is now so complex that not only specialists but also so-called superspecialists are needed to manage complicated cases successfully.

One of the biggest challenges, and greatest opportunities, in ob.gyn. is the need to establish a multidisciplinary health team to the address the needs of today's patients. More than ever, we are working with patients with advanced maternal age having their first pregnancies. More than ever, we are managing patients who have preexisting diabetes and are concurrently overweight or obese. More than ever, our patients are having multiple cesarean deliveries. More than ever, our patients are hoping --perhaps even expecting--to retain their fertility after a complicated delivery More than ever, a single patient may need the guidance and care of not just an ob.gyn. or maternal-fetal medicine subspecialist but also an endocrinologist, cardiologist, diabetologist, genetic counselor, nutritionist--the list could go on.

Although it may seem like a simple idea in theory--integrating health care professionals across disciplines to manage complex cases--it can be challenging in practice. However, only by breaking through the medical science silos and by emphasizing the importance of having a variety of specialists actively participating in the care team can we hope to accelerate and improve the outcome of cases dramatically that may otherwise end poorly. As medicine advances so, too, do the complications that we and our patients expect modern ob.gyn. practice to manage and address successfully. We need to be prepared.

The emergence and continued growth of personalized and preventive medicine in the very near future will catalyze fundamental changes at many different levels in health care and health systems. The need to establish multidisciplinary care teams is already apparent in ob.gyn. but is especially necessary in helping patients who experience complicated deliveries that could jeopardize their immediate and long-term health and fertility.

This month, we have invited M. Ozhan Turan, MD, PhD, the director of fetal therapy and complex obstetric surgery at the University of Maryland, Baltimore, to discuss the use of a multidisciplinary team in the management of patients with placenta accreta and other forms of morbidly adherent placenta.


Dr. Reece is vice president for medical affairs at the University of Maryland, Baltimore, the John Z. and Akiko K. Bowers Distinguished Professor, and dean of the school of medicine. He is the medical editor of this column. He has no disclosures.

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Title Annotation:Master Class
Author:Reece, E. Albert
Publication:OB GYN News
Date:Nov 1, 2017
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