Mean age of childbearing has increased steadily in recent years. This has the effect of increasing the chance of a pregnancy being complicated by coincidental medical conditions and increases the risk that such conditions can impact on women's health. In the United Kingdom  the latest figure collected over the triennium 2000-2002 reveals 3% of deliveries are to women 40 years of age and over. In some units 6% of women are 40 years and older. This reflects a major shift, increasing risk of morbidity from medical disorders, and may be a contributory factor in the increasing indirect deaths in the triennial maternal mortality enquiry.
Management of women with medical disorders is often best coordinated within clinics with both obstetric and medical opinions and midwifery input available. When problems arise such clinics make outpatient management much more convenient for the patient and facilitate good communication between the relevant medical teams. They also serve as a focal point with which the woman may make contact in early pregnancy when treatment changes may need to take place without delay or in later pregnancy if there are problems. The latest triennial enquiry emphasizes the importance of integrated care plans for women with medical disorders, good communication between specialties, and early and senior review and ensuring that women with complications are managed in centres with all relevant expertise.