Division of Maternal Critical Care, Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
Am J Obstet Gynecol. 2021 Jun;224(6):567-573. doi: 10.1016/j.ajog.2020.12.1208. Epub 2020 Dec 24.
The acute rise in maternal morbidity and mortality in the United States is in part because of an increasingly medically complex obstetrical population. An estimated 1% to 3% of all obstetrical patients require intensive care, making timely delivery and availability of critical care imperative. The shifting landscape in obstetrical acuity places a burden on obstetrical providers, many of whom have limited experience in identifying and responding to critical illness. The levels of maternal care definitions by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine designate hospitals based on the availability of obstetrical resources and highlight the need for critical care resources and expertise. The growing need for critical care skills in the evolving contemporary obstetrical landscape serves as an opportunity to redefine the concept of delivery of care for high-risk obstetrical patients. We summarized the key tenets in the prevention of maternal morbidity and mortality, including the use of evidence-based tools for risk stratification and timely referral of patients to facilities with appropriate resources; innovative pathways for hospitals to provide critical care consultations on labor and delivery; and training of obstetrical providers in high-yield critical care skills, such as point-of-care ultrasonography. These critical care-focused interventions are key in addressing an increasingly complex obstetrical patient population while providing an educational foundation for the training of future obstetrical providers.
美国孕产妇发病率和死亡率的急剧上升，部分原因是产科人群的医疗复杂性日益增加。估计所有产科患者中有 1%至 3%需要重症监护，因此及时分娩和提供重症监护至关重要。产科疾病严重程度的变化给产科医生带来了负担，他们中的许多人在识别和应对重症疾病方面经验有限。美国妇产科医师学会和母胎医学学会根据产科资源的可用性对产妇护理水平进行定义，并强调需要重症监护资源和专业知识。在不断发展的当代产科领域，对重症监护技能的需求不断增长，这为重新定义高危产科患者的护理提供了机会。我们总结了预防孕产妇发病率和死亡率的关键原则，包括使用基于证据的风险分层工具以及及时将患者转介到有适当资源的机构；为医院提供创新的途径，以便在分娩和分娩时提供重症监护咨询；以及对产科医生进行高收益重症监护技能的培训，例如即时超声检查。这些以重症监护为重点的干预措施是应对日益复杂的产科患者群体的关键，同时为未来产科医生的培训提供了教育基础。
