Childbirth is a major life event for women and their families. For the majority, the outcome is a healthy mother and a healthy baby. Few women become critically ill during childbirth. The maternal mortality in the UK is low (9.8 per 100 000 maternities). Of the females aged 16–50 years admitted to the critical care unit, 10% had recently given birth and 2.1% were pregnant (approximately 290 per 100 000 maternities). Confidential enquiries into maternal deaths suggest that improvements in care may have made a difference to the outcome of 38% of the women who died and 74% of the women with major obstetric haemorrhage who survived. In many cases the early warning signs and symptoms of impending severe maternal illness or collapse went unrecognised.
Early recognition of a deteriorating pregnant woman continues to remain a challenge due to the rarity of these events compounded by the normal changes in physiology associated with pregnancy and childbirth. Obstetric early warning systems that alert care providers of potential impending critical illness may improve maternal safety. The regular recording and documentation of vital signs, using a Modified Early Obstetric Warning System (MEOWS), was a top recommendation in the UK Confidential Enquiries into Maternal Deaths.
This case study discusses a deteriorating woman who has recently given birth.
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Intensive Care National Audit & Research Centre. Female admissions (aged 16-50 years) to adult, general critical care units in England, Wales and Northern Ireland reported as ‘currently pregnant’ or ‘recently pregnant’. London: ICNARC; 2013.
Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl 1):1-203.