Maternal critical care

Abstract

The UK maternal mortality rate is one of the lowest in the world, at 9.8/100 000 maternities. However, for every maternal death there are at least 70 women who develop severe maternal morbidity, and this rate is rising with increasing body mass index, maternal age, and pre-existing disease. The commonest ‘direct’ cause of death because of pregnancy is thrombosis, and ‘indirect’ cause from a pre-existing problem is cardiovascular disease. The confidential mortality reports and recommendations on mortality MBRRACE-UK have resulted in major improvements in common obstetric problems such as venous thromboebolism, pre-eclampsia, and haemorrhage. Nowadays focus is also directed to examining causes of and improving management of morbidity (as opposed to mortality), often from other disorders such as infection, cardiac, and respiratory disease, resulting in the need for critical care. This chapter discusses maternal critical care, enhanced maternity care, and includes discussion on common conditions causing illness in pregnancy, obstetric emergencies, and reviews and guidelines. There are sections on venous thromboembolism, pre-eclampsia, massive obstetric haemorrhage, obstetric sepsis, cardiac disease, neurological emergencies, liver failure, diabetic emergencies, amniotic fluid embolism, and complications of anaesthesia.