Maternal critical care guideline

Summary

The speaker, an obstetric fellow, introduces a maternal Critical Care guideline developed with a multidisciplinary team. The guideline addresses the care of critically ill women from 20 weeks gestation to 14 days postpartum, covering antenatal, postnatal, and non-obstetric-related conditions. It includes practical advice for anesthetists and critical care staff, particularly around topics like consent for breast milk expression in sedated patients and maintaining maternal-infant contact. Key resources, such as emergency guidelines and pharmacological information, aim to improve care and decision-making for critically unwell mothers, with an emphasis on supporting breastfeeding decisions.

Takeaways

• 📚 The speaker is an outgoing obstetric fellow who has contributed to a Maternal Critical Care guideline, highlighting its relevance to anesthesiologists for both antenatal and postnatal care.
• 🤰 The guideline covers a broad range of women from 20 weeks gestation to 14 days postpartum, including those with non-obstetric critical illnesses.
• 🏥 It was developed in response to the need for specific guidelines for critically unwell maternal patients, as identified in various best practice standards and the GPIX2.
• 🍼 A key consideration is the importance of breastfeeding or breast milk expression for women who are critically unwell or require surgery, and the need for consent in such situations.
• 👩‍⚕️ The guideline is a collaborative effort involving a large group of contributors from various specialties, aiming to provide comprehensive care for critically ill pregnant women.
• 📈 It includes detailed information on drug pharmacokinetics and pharmacodynamics in pregnancy and breastfeeding, which is crucial for anesthesiologists when prescribing medications.
• 👶 There's an emphasis on maintaining contact between mother and baby, with procedures in place for facilitating this, even when the mother is sedated and on intensive care.
• 📊 The guideline is designed for easy access to information, with key points and emergency contacts readily available, and it's structured to allow quick reference in critical situations.
• 💊 The document provides a comprehensive review of the top 50 drugs used in critical care, with specific advice on their use during pregnancy and breastfeeding.
• 🔄 The guideline is a living document, with plans for continuous improvement based on feedback and experience, emphasizing the importance of keeping it up-to-date and practical.

Q & A

What is the main purpose of the guideline discussed in the transcript?

The main purpose of the guideline is to provide specific recommendations for the care of critically unwell maternal patients, from 20 weeks gestation to 14 days postpartum, covering a wide range of women who may present with critical illnesses that are not obstetric-related.

Who are the key contributors to the guideline mentioned in the transcript?

The guideline was written by Dr. Cantelo, Claire Llewellyn, a senior matron on ITU, and the speaker, who is an outgoing obstetric fellow. It was also contributed to by a large group of people from various specialties.

Why is the guideline relevant to anesthesiologists?

The guideline is relevant to anesthesiologists because it contains information that can be useful for managing antenatal and postnatal women who are critically unwell, as well as those presenting for surgery during their second or third trimester.

What is the significance of the guideline's coverage from 20 weeks gestation to 14 days postpartum?

The guideline's coverage is significant because it encompasses a broad range of women who may present with critical illnesses, including those not related to obstetrics, ensuring comprehensive care for women during the perinatal period.

What are some unique challenges faced when caring for critically unwell pregnant or postnatal women?

Unique challenges include considerations for breastfeeding or breast milk expression, obtaining consent for medical procedures in sedated patients, and maintaining contact between the mother and baby while the mother is in intensive care.

Why is it important to discuss breastfeeding or breast milk expression with critically unwell women?

It is important to discuss breastfeeding or breast milk expression because some women may need or want to have their breast milk expressed if their baby is delivered, and obtaining consent for this in a sedated patient is a specific and complex issue.

What does the guideline suggest regarding maintaining contact between a mother and her baby while she is in intensive care?

The guideline suggests that there are systems in place to maintain contact, such as bringing neonates to intensive care when appropriate and taking videos for the mother to see, even if she is sedated and ventilated.

What is included in the appendices of the guideline that could be useful for anesthesiologists?

The appendices include safety alert posters, a list of emergency obstetric drugs available in the Omnicell, phone numbers for key personnel, and a comprehensive document on the pharmacodynamics and pharmacokinetics of the top 50 drugs used in critical care during pregnancy and breastfeeding.

How does the guideline address the use of drugs in critical care for pregnant and breastfeeding women?

The guideline provides detailed information on the appropriate use of drugs in critical care for pregnant and breastfeeding women, including a document created by critical care pharmacists that covers the top 50 drugs used, their safety, and considerations for breastfeeding.

What is the guideline's stance on supporting maternal choice regarding breastfeeding?

The guideline supports maternal choice by providing information on drug safety during breastfeeding, aiming to prevent unnecessary discouragement of breastfeeding and to allow women to make informed decisions based on the best available evidence.