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Maternal critical care: Informing and influencing local commissioners

02 April 2018
12 min read
Volume 26 · Issue 4

Abstract

Background

Relatively little is known about women who receive higher levels of care within maternity services, such as women with unanticipated pregnancy complications, high-risk pregnancies, complex maternal medical conditions and/or obstetric complications, and women who are or become critically ill.

Aim

To inform local health commissioners on the complexity of activity in a tertiary referral maternity and neonatal service.

Methods

A retrospective audit was completed, applying a local modification of the Intensive Care Society's levels of support for critical care agreed by obstetric, anaesthetic and midwifery teams. The audit included 525 women cared for in the designated critical care rooms over 1 year.

Findings

The findings show that haemorrhage (40%), hypertensive disorders (16%) and sepsis (12%) were the main reasons for maternal critical care, with 44% of women requiring levels 2 and 3 critical care. This audit confirmed adequate, equitable provision of appropriate maternal critical care, but identified a need for written guidance and training programmes on the transfer of critically ill pregnant or postpartum women.

Conclusions

This audit found that a standardised approach to local and regional data collection and agreed definitions of maternal critical care levels were essential for effective commissioning of maternity services to ensure funding by the local commissioning group is influenced by acuity and not births alone.

This retrospective audit of maternal critical care was undertaken during 2015 by a consultant midwife and intrapartum midwifery practice educator. The aim was to inform local health commissioners on the complexity of activity in a tertiary referral maternity and neonatal service in Belfast Health and Social Care Trust (BHSCT).

In the UK and Ireland during 2013–15, 556 women died during birth or up to 1 year postpartum, according to the Saving Lives, Improving Mothers' Care report (Knight et al, 2017). This indicated there was no change in the overall maternal death rate between 2010–2012 and 2013-2015, which remains at 8.8 women per 100 000, two-thirds of whom had pre-existing medical problems. The report showed a significant decrease in indirect maternal mortality, primarily due to a decrease in influenza deaths and deaths from maternal sepsis.

While it is essential to continue to audit cases of maternal mortality, a review of cases requiring maternal critical care, which occurs more frequently, should provide a more clinically relevant appraisal of the challenges and requirements in terms of maternity service provision and development.

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