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.
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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 |
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 |
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Vyas, L., Menghani, R. (2016). Transport of the Critically Ill Obstetric Patient. In: Gandhi, A., Malhotra, N., Malhotra, J., Gupta, N., Bora, N. (eds) Principles of Critical Care in Obstetrics. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2686-4_36
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