Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low-and middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in highincome countries, and from 2% to 43.6% in low-and middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries. Bedside assessment tools, such as early warning scores, may help to identify critically ill patients and those at risk of deterioration. There is a lack of uniformity in definitions, identification and treatment of critically ill pregnant patients, especially in resourcelimited settings. Our aims were to (i) propose a more practical definition of maternal critical care, (ii) discuss maternal mortality in the setting of limited accessibility of critical care units, (iii) provide some accessible tools to improve identification of obstetric patients who may become critically ill, and (iv) confront challenges in providing maternal critical care in resource-limited settings. To improve maternal critical care, training programmes should embrace modern technological educational aids and incorporate new tools and technologies that assist prediction of critical illness in the pregnant patient. The goal must be improved outcomes following early interventions, early initiation of resuscitation, and early transfer to an appropriate level of care, whenever possible.
Summary
Maternal critical care is a developing area of clinical practice. Looking after a critically ill woman requires a multidisciplinary team that must endeavour to maintain the relative normality of pregnancy. Whilst consideration of the fetus should be taken when making clinical decisions regarding maternal care, unfounded concerns for the fetus can contribute to therapeutic inertia such that potentially life‐saving therapies are denied to pregnant women. The management of a critically ill obstetric patient must reflect, as closely as possible, the management of critical illness outside pregnancy. We will discuss some of the current evidence and concepts around this emerging area in obstetrics, including enhanced maternity care, maternal medicine networks and clinical care.
Este artículo presenta los patrones que determinaron el ingreso de las gestantes críticamente enfermas a la Unidad de Cuidados Intensivos (UCI) o de Alta Dependencia Obstétrica (UAD), y las causas de complicaciones y muerte más frecuentes, al igual que los factores que afectan el pronóstico perinatal. Se plantea la implementación de las Unidades de Alta Dependencia Obstétrica para el manejo de las gestantes críticamente enfermas, y el entrenamiento del personal involucrado en el manejo obstétrico de estas pacientes.
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