Critical Care in Obstetrics: A Strategy for Addressing Maternal Mortality.

Padilla, Cesar; Markwei ScM, Metabel; Rae Easter, Sarah; Fox, Karin A; Shamshirsaz, Amir A; Foley, Michael R

The acute rise in maternal morbidity and mortality in the United States is in part due to an increasingly medically complex obstetric population. An estimated 1-3% of all obstetric patients require intensive care, making the timely delivery and availability of critical care imperative. The shifting landscape in obstetric acuity places a burden on obstetric providers, many of whom have limited experience in identifying and responding to critical illness. The Levels of Maternal Care definitions by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) designate hospitals based on the availability of obstetric resources and highlight the need for critical care resources and expertise. The growing need for critical care skills in the evolving contemporary obstetric landscape serves as an opportunity to redefine the concept of the delivery of care for high-risk obstetric patients. We summarize key tenets in the prevention of maternal morbidity and mortality, including the use of evidence-based tools for risk stratification and timely referral of patients to facilities with appropriate resources; innovative pathways for hospitals to provide critical care consultations on labor and delivery; and the training of obstetric providers in high-yield critical care skills such as point-of-care ultrasonography. These critical care focused interventions are key in addressing an increasingly complex obstetric patient population while providing an educational foundation for the training of future obstetric providers.