Chapter 19: Critical Care

Critical Care: Specific recommendations

The early detection of severe illness in mothers remains a challenge to all involved in their care. The relative rarity of such events combined with the normal changes in physiology associated with pregnancy and childbirth compounds the problem. There is a need to introduce education, training and other processes which will improve detection rates.

Modified early warning scoring systems have been successfully introduced in other areas of clinical practice and systems appropriately modified for the obstetric patient have been described. These should be introduced for all acute obstetric admissions including early pregnancy.

Changes in medical training and work patterns have reduced the exposure of junior medical staff to life threatening illness. This should be addressed by the introduction of simulation training, preferably as part of a nationally accredited scheme.

The management of obstetric emergencies such as massive haemorrhage is necessarily team based. Maternity teams should be expected to demonstrate their competency in scenario based training and protocols for the management of obstetric emergencies should be subjected to regular review.

In the future, all staff, including temporary staff, involved in the care of seriously sick women should have undertaken appropriate competency-based training and have a record of success.