Maternal critical care: Informing and influencing local commissioners.

Background: Relatively little is known about women who receive higher levels of care within maternity services, such as women with unanticipated pregnancy complications, high-risk pregnancies, complex maternal medical conditions and/or obstetric complications, and women who are or become critically ill. Aim: To inform local health commissioners on the complexity of activity in a tertiary referral maternity and neonatal service. Methods: A retrospective audit was completed, applying a local modification of the Intensive Care Society's levels of support for critical care agreed by obstetric, anaesthetic and midwifery teams. The audit included 525 women cared for in the designated critical care rooms over 1 year. Findings: The findings show that haemorrhage (40%), hypertensive disorders (16%) and sepsis (12%) were the main reasons for maternal critical care, with 44% of women requiring levels 2 and 3 critical care. This audit confirmed adequate, equitable provision of appropriate maternal critical care, but identified a need for written guidance and training programmes on the transfer of critically ill pregnant or postpartum women. Conclusions: This audit found that a standardised approach to local and regional data collection and agreed definitions of maternal critical care levels were essential for effective commissioning of maternity services to ensure funding by the local commissioning group is influenced by acuity and not births alone. [ABSTRACT FROM AUTHOR]