Pregnancy is a period of hope and anticipation for many families, but for some women, it can become a period of serious medical risk when complications threaten the mother, the unborn baby, or both. To address this, Muhimbili National Hospital (MNH) in Tanzania has established a Fetal Maternal Medicine (FMM) unit to provide specialized care for high-risk pregnancies. The unit will offer a coordinated chain of care, including a high-risk pregnancy clinic, modern investigations, specialized monitoring, intensive care, and newborn services.
The need for such services is underscored by the global burden of maternal and newborn deaths. According to the World Health Organisation (WHO), more than 700 women die every day from preventable causes related to pregnancy and childbirth. In Tanzania, the maternal mortality ratio was estimated to be 275.8 deaths per 100,000 live births in 2023, while a separate figure from the 2022 Demographic and Health Survey reported a ratio of 104 deaths per 100,000 live births. The newborn picture is also concerning, with nearly two million babies stillborn globally each year.
The FMM unit at Muhimbili will focus on pregnancies with significant risks to mothers and unborn babies. The unit's diagnostic capacity will include detailed anomaly ultrasound scans, Doppler assessment of blood flow between mother and fetus, fetal echocardiography, and amniocentesis. WHO recommends one ultrasound before 24 weeks of pregnancy to help estimate gestational age and improve detection of fetal abnormalities and multiple pregnancies. The FMM unit will provide an important extension of antenatal care, particularly for women with additional risk factors.
The value of early detection is especially clear in hypertensive disorders of pregnancy, which account for around 16% of maternal deaths globally. Pre-eclampsia can progress to eclampsia, causing seizures and placing both mother and baby at risk. Women living with chronic hypertension, diabetes, kidney or heart disease may require closer monitoring throughout pregnancy. The FMM unit will enable clinicians to identify problems early enough for intervention before a pregnancy becomes an emergency.
Muhimbili plans to develop capacity for fetal therapy, including procedures such as blood transfusion for a baby with severe anaemia while still in the womb. The unit will also facilitate multidisciplinary management of complex cases, coordinating a team of obstetricians, neonatologists, paediatric surgeons, and cardiologists. This approach means that the place and timing of delivery can become part of the treatment plan, which is particularly relevant to Muhimbili as Tanzania's national referral hospital.
Hospital data shows that approximately 90% of mothers who died at Muhimbili had been referred from other facilities, with about two-thirds coming from municipal hospitals in Dar es Salaam. The data also identified shortages of blood, specialists, and equipment among factors contributing to referrals. An earlier Muhimbili study recorded a maternal mortality ratio of 1,541 deaths per 100,000 live births in 2011, highlighting the consequences of delayed referral and late presentation.
According to Dr. Delilah Kimambo, Executive Director of Muhimbili National Hospital, the FMM unit will manage high-risk pregnancies and provide specialized care to identify problems early. The unit's launch is a significant step towards reducing maternal and newborn mortality in Tanzania, and Muhimbili's national referral status means it will receive women with complicated pregnancies from different parts of the country.
Key points
- Muhimbili National Hospital launches Fetal Maternal Medicine unit to improve care for high-risk pregnancies.
- The unit will provide specialized care, including detailed anomaly ultrasound scans and Doppler assessment of blood flow.
- Early detection of pregnancy complications can significantly reduce maternal and newborn mortality in Tanzania.
