Organizing An

Obstetrical
Critical care Unit
 Medical/Surgical ICU Obstetric ICU
 Critical care is primary objective  Ensures adequate provision of
 Severely morbid cases requiring obstetric and critical care
prolonged admission (Weeks to simultaneously
months)  Overall short duration of stay
 Moderate to poor rates of even in critical cases (median
survival stay – 2 days)
 Residual morbidity high  Very high rates of survival
 Residual morbidity is very low
(intact survival high)

High cost, low impact Low cost, High Impact

intervention Intervention
Staff pattern
 Charecterstics and job chart of Team
Members---
 Obstetrician---Head of the team , should be
skilled obstetrical care provider along with the
skilled knowledge of maternal – fetalMedicine.
His skilled training in this field will help in
assessing physiological changes in pregnancy in
body systems and their effect in utero---
compromise / compensation and complication to
fetus that can jeopardize the well being of fetus
and mother.
Characterstics and job chart of Team
Members---
 Intensivists-- physicians---
Whose day to day work is in the management
of critically ill patient’s vital sign care– His skills
help in early identification of forth coming
complications and timely management, in
reducing fetal and maternal mortality and late
sequelae , reduce cost factor and hospital stay
too.
Time to time he may need immediate help of
specialists and super specialists of other
medical disciplines as and when a new
problem develops.
Characterstics and job chart of Team
Members---
 Nursing Staff—
High risk obstetric nursing care requires a
confident, companssionate , skilled and well
trained nurse willing to under take complexities
and challenges of higher acuity care.
Staffing pattern should be should be 1:1nurse
to patient ratio.
At times it may be 2: 1 in cases of unstable
patients.
 Care of New Born during
mother's stay at ICU/HDU:
Decision to keep new born with mother will be based on the maternal conditon
If mother is critically ill (e.g. multi organ failure or ventilator support), newborn
should be cared by the
relatives or by the paediatric units of the respective hospitals.
Majority of mothers admitted to ICU/HDU will require additional support to care
for new born.
Whenever mother is conscious and able to breastfeed child, the same should
be encouraged.
New born can also be roomed in with mother wherever possible.
All new born shall receive check up by a paediatrician to screen for any new
born defect or complications.
Paediatricians will play an important part in overall care of new born during
mother’s stay at ICU.
 Criteria for
admission

High probability of MI Compromised gas

Hemodynamically Eclampsia
exchange
unstable Arrhythmias Seizure from
At risk for impending known or
Congestive heart failure respiratory failure
Pacing requirement unknown cause
(Asthma/Pneumonia/P
Urgent/Emergent ul monary edema) Known prior
hypertensive crises neurologic event
Requirement for that places current
with/without evidence
of end organ failure minute- minute maternal well
HELLPSyndrome monitoring of vital being in jeopardy
signs
Eclampsia
(suspected/confirmed
PE) or need for
aggressive pulmonary
physiotherapy

1
0
 Criteria for
admission

Need for UGI/LGI bleeding DKA

frequent requiring Thyrotoxicosis/
neurologic transfusion therapy Storm
assessment Hepatic failure Complicated
parathyroid/cal
Need for cium
continuous metabolism
pulmonary/card Congenital
iac monitoring metabolic
that is at risk disorders
for
hemodynamic
1
instability
1
 Criteria for
admission
• Surgical • Renal
–Severe hemorrhage –Unstable
requiring MTP AKI
Morbidly adherent –Chronic
placenta Kidney
PPH Disease/un
stable
Peripartum
hysterectomy that –CRRT
requires close –
monitoring/fluid Plasmaphere
resuscitation sis
1
2
 Criteria for
• Miscellaneous
admission –SLEcrisis (Lupus
Nephritis/Cerebritis)
• Sepsis/Septic shock –Sickle Cell Crisis
–Hypotensive (Sickle lung disease)
–Decreased –Thrombotic
oxygen microangiopathies
delivery/elevated –Trauma
Lactate levels –Thermal and electrical
–Gram injury
negative/positive
bacteremia
–Vasopressor
–Multisystem end
organ
dysfunction/failur
1
3
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