This report can be downloaded as a pdf below:
Introduction to document
The remit in producing this document was to summarise, in one place, existing standards and recommendations relevant to the care of the pregnant or recently pregnant critically ill woman for Maternity and Critical Care Services and Commissioners to respond to. There was no remit to make new recommendations. This document was drafted by the Maternal Critical Care Working Group, a subcommittee of the Joint Standing Committee of the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Anaesthetists (RCoA) together with representation from the Royal College of Midwives (RCM), Intensive Care Society (ICS), British Maternal and Fetal Medicine Society (BMFMS), the Obstetric Anaesthetists Association (OAA) and the Department of Health (DH). It was hosted by the Royal College of Anaesthetists. The multidisciplinary Working Group was formed to look at source documents relating to matters of critical care in the parturient and to provide critical appraisal and advice for those tasked with providing this care to women.
Childbirth is a major life event for women and their families. The few women who become critically ill during this time should receive the same standard of care for both their pregnancy related and critical care needs, delivered by professionals with the same level of competences irrespective of whether these are provided in a maternity or general critical care setting.
Background
Maternal critical care is an area which is less discussed than other parts of obstetric, midwifery and critical care practice. There may be many reasons for this. Of late, however, there has been a growing need to address this area from a national point of view: to collate, to standardise, to share and to learn. Maternal mortality has been analysed by the confidential enquiries and what has become apparent is that there is still a significant number of deaths associated with suboptimal care. Furthermore, there are recurrent and new themes emerging, most recently the problem of maternal sepsis and mortality has a higher incidence among ethnic minority groups, particularly black African women, than among white
women.1 For every death there are nine women who develop severe maternal morbidity. We need to address the implementation of the most up-to-date published standards on recognising, and managing with the appropriate interventions, maternal critical care and its sequelae (long-term organ dysfunction, hysterectomy, fetal death, etc). The aim of this document is to identify and bring together reports on critical care and view them with respect to maternity services.
Aims and objectives
The aim of this work was to review the evidence base and give examples of models of care to ensure that both maternal and critical care aspects of the pathway are delivered equitably, always remembering the goal of keeping mother and baby together unless precluded by a clinical indication.
