Maternal Critical Care

Audrey Quinn and Laura Vincent look forward to the Maternal Critical Care session at the 2018 'State of the Art' Meeting.

It’s never a good thing to be timetabled for an SOA 2018 Maternal Critical Care (MCC) session at the same time as the crowd-pleasing van Tulleken twins!  Fortunately, it’s going to be easy for us to illustrate that this session could revolutionise your intensive care practice; you can watch the brothers on the webcasts at home with a cuppa over Christmas!

Irrespective of whether you work in a busy district general hospital or a tertiary centre, the MCC session will illustrate the complexity of MCC delivery. In the UK, we have one of the lowest maternal mortality rates in the world and patients who suffer obstetric complications generally receive excellent care, yet the morbidity faced by this cohort remains significant.

Multi-professional streamlined care is essential from the point of admission to ensure timely recognition, and optimal management of the sick mother. They must receive consistent care wherever they are in the hospital: medical ward, surgical ward, maternity unit or critical care unit. Good teamwork is of the utmost importance with both a young woman and an unborn baby at risk.

Progress in MCC over recent decades has been hampered by political and public infatuation with "normal" childbirth, and with the changes in midwifery education towards "normalisation" and away from ‘sickness’ and deterioration. This is now being addressed and reversed at both undergraduate, and postgraduate level by the Royal College of Midwives with ‘Enhanced Maternal Care’.  Doctors also face challenges.  Earlier sub-specialisation in the clinical training pathways of obstetricians, physicians, anaesthetists and intensivists has impacted on the ability to assemble an experienced team when a sick mother requires critical care.  This is particularly acute when mothers present out of hours, in an overstretched maternity ward environment.

For many reasons, obstetric care has become isolated within the hospital and a ‘silo’ mentality can prevail, with pregnant mothers missing out on NHS innovations devised, funded and delivered globally: the lack of a national standardised maternity early warning score (EWS), electronic data collection and rapid response systems for the deteriorating obstetric patient are all good examples.

In the MCC session we will reflect on the many diverse challenges encountered in caring for the sick mother and review the recently launched national multi-professional guidelines for MCC. We will suggest practical solutions that can be replicated in your region (as already enacted by Sarah Winfield, one of a new breed of obstetricians, interested in collaboration with intensivists and supported by NHS England’s maternity network).

The third and fourth talks are from Oxford University research groups. Peter Watkinson will outline some exciting new research around normal maternal physiology, which may point the way to evidence-based thresholds for EWS’s.  Lisa Hinton will present an in-depth examination of sick mothers' perceptions of critical illness, highlighting the need to enhance their (and their family’s) psychological and physical recovery.

There will undoubtedly be some controversial discussion at the end of the session about how these issues are addressed going forward within the current systems in which we work.

We are entering a new era of collaboration between dedicated multi-professional practitioners, united by their commitment to deliver the highest standard of care to the sick mother, wherever they are physically located within an organisation.  Please come and find out more about how you can drive this forward in your institution and contribute to better care for sick mothers and their babies in the future.

See you in London next week. The countdown has begun…

Banner photo from - led by Audrey Quinn