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Why our hospitals need maternal critical care units

Reproductive Health - By Kizito Lubano

I am motivated by the ongoing renovations in a major teaching and referral hospital to improve comprehensive maternity services.

This has led to discussions on the need for specialised dedicated maternal critical care units that will tend to the unique needs of mothers and newborns.

The fact is, for every maternal death, there are nine women who develop severe maternal ‘near-miss’ morbidity and many of these women will need critical care.

Being in a critical care unit is nearly always an unforeseen and frightening experience for women and their families. And while critical illness may be uncommon, it is a potentially devastating complication in pregnancy.

The obstetric population is changing, increasingly presenting clinicians with older mothers who have pre-existing disorders and advanced chronic medical conditions. Multidisciplinary approaches are therefore essential for these women and require urgent attention.

A deep insight and complete understanding of the physiological needs of both mother and foetus pose a big challenge during critical illness situations.

The availability of well-equipped and state-of-the-art modern labor rooms, quality obstetrical services, evidence-based practice, financial adequacy, and specialised centres for such admissions are likely to reduce the number of obstetric admissions to intensive care units

The diagnoses precipitating admission to critical care are predictable and include massive haemorrhage (profuse loss of blood from a ruptured blood vessel), eclampsia, sepsis (infection of a wound), thromboembolism (obstruction of a blood vessel by a blood clot), acute organ dysfunction.

Others include anaesthesia-related morbidity such as aspiration (trouble breathing), anaphylaxis (acute allergic reaction) and muscle relaxant-related problems.

The biggest challenge in dealing with such a large load of critically ill obstetric patients is the shortage of qualified intensive care specialists for handling such cases in a developing nation like Kenya

It is therefore imperative that major referral and teaching hospitals establish maternity and critical care services. They also ought to design pathways at local levels which will ensure that a critically ill patient accesses equitable care irrespective of location.

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