High dependency care in an obstetric setting in the UK

Abstract

SummaryOur objective was to establish the utilisation and pattern of high dependency care in a tertiary referral obstetric unit. Data of pregnant or recently pregnant women admitted to the obstetric high dependency unit from 1984 to 2007 were included to evaluate the admission rate. Four years’ information of an ongoing prospective audit was collated to identify the indications for admission, maternal monitoring, transfers to intensive care unit, and location of the baby. The overall high dependency unit admission rate is 2.67%, but increased to 5.01% in the most recent 4 years. Massive obstetric haemorrhage is now the most common reason for admission. Invasive monitoring was undertaken in 30% of women. Two‐thirds of neonates (66.3%) stayed with their critically ill mothers in the high dependency unit. Transfer to the intensive care unit was needed in 1.4 per 1000 deliveries conducted. We conclude that obstetric high dependency care provides holistic care from midwives, obstetricians and anaesthetists while retaining the opportunity of early bonding with babies for critically ill mothers.

Broken epidural catheter

“…Their length of stay in the delivery suite was considerably longer than the mean (SD) length of stay of all parturients (58 h and 64 h vs 12 (11) h, respectively). Our data are consistent with a previously reported admission rate of 5% for obstetric high dependency care in a UK tertiary referral hospital [4]. A recent publication from the multidisciplinary Maternal Critical Care Working Group recommended that the same standard of care should be provided for all critically ill women in labour, regardless of aetiology (pregnancy-related or otherwise) or point of delivery (maternity suite or general critical care setting) [5].…”

Obstetric high-dependency care: a 2005–06 UK survey of practice and facilities

“…2 A questionnaire was sent to 228 obstetric units in the United Kingdom in September 2006 to quantify the availability and staffing for obstetric high-dependency care during the period 2005-06. The impact on intensive care unit (ICU) referral rates was also explored.…”

“…4 The admission rate to these beds (4.2%) was higher than the estimate by the Safer Childbirth report of 1% 5 and similar to the figure quoted by Saravanakumar et al of 5.01%. 2 Despite 40% of units having an early warning scoring system in place, on further analysis only 40% of these appear to be using a validated scoring system. Tachypnoea is a sensitive indicator of physiological compromise yet five units used a scoring system that did not include respiratory rate.…”

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial

“…1 Life-threatening blood loss is the primary indication for 95.6% of emergency hysterectomies in labour. 2 Haemorrhage is the most common cause for maternal critical care admission [3][4][5] and places a profound health burden on the childbearing population during an important life event. Haemorrhage is more common in women who have caesarean sections, 6 particularly when indicated for conditions such as placenta praevia (low-lying placenta) or when an emergency caesarean section is required.…”