Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Cracow, Poland.
Department of Anaesthetics and Intensive Care, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Anaesth Crit Care Pain Med. 2024 Jun;43(3):101355. doi: 10.1016/j.accpm.2024.101355. Epub 2024 Feb 13.
To evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM).
From September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs. Within ICUs, we examined the availability of trained staff, response to obstetric emergencies, leadership, and data collection.
1133 responses were evaluated. MEOWS use was 34.5%. Non-obstetric early warning scores were being used. 21.4% (242) of OUs provided invasive monitoring in the OU. A quarter lacked access to onsite HDU beds. In cases of SMM, up to 13.8% of all OUs indicated the need for transfer to another hospital. The transfer rate was highest (74.0%) in small units. 81.9% of centers provided onsite ICU facilities to obstetric patients. Over 90% of the onsite ICUs provided daily specialist obstetric reviews but lacked immediate access to key resources: 3.4% - uterotonic drugs, 7.5% - neonatal resuscitation equipment, 9.2% - neonatal resuscitation team, 11.4% - perimortem cesarean section equipment. 41.2% reported obstetric data to a national database.
Gaps in provision exist for obstetric patients with SMM in Europe, potentially compromising patient safety and experience. MEOWS use in OUs was low, while access to invasive monitoring and onsite HDU and ICU facilities was variable. ICUs frequently lacked resources and did not universally collect obstetric data for quality control.
评估产科单位（OBUs）和重症监护单位（ICUs）对严重产妇发病率（SMM）的准备情况。
2021 年 9 月至 2022 年 1 月，一项国际多中心横断面研究调查了 26 个世卫组织欧洲区域国家的 OBUs。我们评估了改良早期产科预警评分（MEOWS）的使用情况、四种 SMM 临床情况的处理方法、OBUs 中侵入性监测的可用性以及获得高依赖单位（HDU）和现场 ICU 的途径。在 ICU 内，我们检查了训练有素的工作人员的可用性、对产科急症的反应、领导力和数据收集。
评估了 1133 份回复。MEOWS 的使用率为 34.5%。正在使用非产科早期预警评分。21.4%（242）的 OBUs 在 OBU 提供侵入性监测。四分之一的单位缺乏现场 HDU 床位。在发生 SMM 的情况下，多达 13.8%的 OBUs 表示需要转院。小单位的转院率最高（74.0%）。81.9%的中心为产科患者提供现场 ICU 设施。超过 90%的现场 ICU 每天为产科患者提供专科产科评估，但缺乏对关键资源的即时访问：3.4% - 宫缩素药物，7.5% - 新生儿复苏设备，9.2% - 新生儿复苏团队，11.4% - 围产儿剖宫产设备。41.2%的单位向国家数据库报告产科数据。
欧洲的 SMM 产科患者的供应存在差距，可能危及患者安全和体验。OBUs 中 MEOWS 的使用率较低，而侵入性监测以及现场 HDU 和 ICU 设施的可用性各不相同。ICU 经常缺乏资源，并且并非普遍为质量控制收集产科数据。
