PM.56 Audit of Care of Critically Ill Pregnant Women
Aim To review series of critically ill obstetric patients admitted to ITU and to formulate a guideline for the care of these women.
Background The women who become critically ill during pregnancy 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.1
Methods Retrospective study of 55 women who were admitted to critical care unit from 01/01/2006 to 31/12/2011.Patients were identified by ITU database.
Results Average ITU stay was 1–2 days in 50% of cases. 92% of patients were admitted postpartum. Massive obstetric haemorrhage (54%), sepsis (13%), Pre eclampsia/HELLP/Eclampsia (11%) and swine flu (5.4%) were the main indications.55% of the patients were mechanically ventilated.100% compliance with MEWS chart was observed. The most common interventions were arterial line (64%) and CVP line (35%). VTE assessment on admission to ITU was observed in 65%, daltaparin (74%) and TEDS (74%) of cases. One case of group A streptococcus was seen. Maternal mortality was nil. Debriefing of the family (61%) and debriefing of patient (78%) cases. Datix completed (10%), external transfer (5.4%) cases.
Conclusions Massive obstetric haemorrhage, sepsis and pre eclampsia are the main reasons for admissions.
Recommendations Documentation of patient and family debrief needs to be improved. All these women should be seen in gynaecology follow up clinic for debriefing. Guidelines for critically ill pregnant or recently pregnant women and sepsis in pregnancy and puerperium should be formulated.
Providing equity of critical and maternity care for the critically ill pregnant or recently pregnant woman, July 2011, Joint RCOG guideline.