Transport of the Critically Ill Obstetric Patient

Abstract

The critically ill pregnant or postpartum woman should receive an equitable standard of care to address their pregnancy-related and critical care needs. Safe transport of critically ill patients requires accurate assessment and stabilisation of patients before transport. The transport itself must be justified. Whatever benefits of proposed interventions must outweigh the risks of moving the critically ill patient and those posed by the interventions themselves.

Safe transport requires the deployment of appropriately trained staff, essential equipment and effective liaison between referring, transporting and receiving staff. The plan should clearly identify the transfer of care from a named consultant (i.e. Dr A Obstetrics) to a named consultant (i.e. Dr B, Critical Care). There must be a named consultant obstetrician who will assume responsibility for the ongoing obstetric care of the patient at the receiving hospital and there must be communication between this obstetrician and the referring obstetrician.

Appendices

Appendix-1: Maternity Modified Obstetric Warning System (MOWS)

Each parameter is scored and action taken according to the total.

	3	2	1	0	1	2	3
Resp rate		Less than 8		9–18	19–25	26–30	More than 30
Pulse rate		Less than 40	40–50	51–100	101–110	111–129	More than 129
BP Systolic	Less than 70	71–80	81–100	101–159	160–199	200	More than 200
BP Diastolic				Less than 95	95–109	More than 110
Conscious level	Unresponsive	Responds to pain	Responds to voice	Alert	Irritated
Urine hourly (ml/h) or in 24-h rate	0	Less than 30 (less than 720 ml)	Less than 45 (less than 1000 ml)	More			V6.1 Nov 2011

1. Originally adapted from Morgan et al. [12]
2. Action to be taken

3. 0	Repeat observations when appropriate for clinical scenario - at least daily
   1	Minimum of 4 hourly observations as there is potential for deterioration
   2	Inform midwife in charge, obstetric registrar. Minimum 1 hourly observations
   3	Inform senior midwife, obstetric and anaesthetic staff. Minimum ½ hourly observations
   4 or more	As above but the consultant obstetrician and consultant anaesthetist should be informed
   	If no one is available to review the patient, inform the outreach team

Appendix 2: Transport documentation

The following information should be recorded on transport documentation

Transfer details

Patient’s name, address, date of birth

Next of kin, what information they have been given and by whom

Referring hospital, ward/unit and contact telephone number

Name of referring doctor and contact telephone number

Receiving hospital, ward/unit and contact telephone number

Name of receiving doctor and contact telephone number

Names and status of the escorting personnel

Medical summary

Primary reason for admission to the referring unit

History and past history

Dates of admission/delivery/operations/procedures

Intubation history, ventilatory support

Cardiovascular status including inotrope and vasopressor requirements

Other medication and fluids

Type of lines inserted and dates of insertion