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High dependency and intensive care 

High dependency and intensive care
Chapter:
High dependency and intensive care
Author(s):

Philip Barclay

and Helen Scholefield

DOI:
10.1093/med/9780198713333.003.0030
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date: 03 December 2020

The development of maternal critical care is essential in reducing morbidity and mortality due to a substandard level of care. The level of critical care should depend upon the patient’s severity of illness, not their physical location. Escalation to level 3 (intensive) care is uncommon in pregnancy, with a median admission rate of 2.7 per 1000 births, mainly due to hypertensive disorders of pregnancy and haemorrhage. Maternal ‘near misses’ occur more frequently, with 6.5 per 1000 births meeting Mantel’s criteria, of which 85% is due to major obstetric haemorrhage. The admission rate to maternal high dependency units (level 2 care) varies from 1% to 5%. Acute physiological scoring systems have been found to be reliable when applied to parturients receiving level 3 care but overestimate mortality. Maternal early warning scores have been derived from simplified versions of these systems, with allowance made for physiological changes seen in pregnancy. There are many different maternity scoring systems in use throughout England and Wales. All share the same principle that parameters should be recorded regularly during the hospital stay, with deviations from normal quantified, recorded, and acted upon. A chain of response is then required to ensure that suitably qualified staff, possessing appropriate critical care competencies, attend in a timely fashion. Appropriate resources must be available with equipment readily to hand and suitably trained staff so that invasive monitoring can be used. Clear admission criteria are required for level 2 care within the delivery suite and escalation to level 3, with suitable arrangements for transfer.

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