Newswise — For most women, pregnancy and birth are low-risk, but for others, pre-existing conditions and complications can lead to serious illness, disability and death.
An estimated 1 to 3 percent of all pregnant women will require critical care in the United States each year. Despite many initiatives to improve outcomes, the U.S. maternal mortality rate increased more than 26 percent over 14 years, from 18.8 deaths per 100,000 patients in 2000 to 23.8 in 2014.
The fall 2018 issue of AACN Advanced Critical Care focuses on critical care obstetrics, with a collection of articles about the most common conditions and complications of pregnancy that result in critical illness, as well as best practices for care.
One of the symposium articles, “Evidence-Based Strategies for Maternal Stabilization and Rescue in Obstetric Hemorrhage,” reviews recent advances in the care of obstetric patients experiencing a life-threatening hemorrhage. It includes links to comprehensive evidence-based resources and best practices for managing patients who hemorrhage.
Obstetric hemorrhage is the leading cause of death during pregnancy throughout the world and one of the most frequent causes of maternal death in the United States. It’s also one of the most avoidable; an estimated 70 percent of maternal deaths from obstetric hemorrhage were preventable.
“Critical care for the pregnant patient may occur in obstetric units, critical care units or one that combines the two specialties. Regardless of the setting, an interprofessional, collaborative model is key to optimize outcomes for the woman, fetus and newborn,” said author Carol Harvey, MS, BSN, RNC-OB, C-EFM. She is a clinical specialist in high-risk obstetrics in the divisions of Women’s Services and Patient Care Administration at Northside Hospital, Atlanta.
Obstetric hemorrhage can occur at any time during pregnancy, but those that occur at or near the time of birth and immediately after delivery are the most common and are responsible for the greatest number of maternal deaths.
Risk assessment tools can help identify pregnant women at risk for hemorrhage, but up to 30 percent of women who have a hemorrhage after giving birth did not have risk factors. Therefore, all obstetric providers and institutions where deliveries occur need to be prepared to manage postpartum hemorrhage.
Strategies that include early recognition, accurate measurement of blood loss, standardized assessment, timely intervention and massive transfusion protocols are effective in reducing maternal morbidity and mortality from obstetric hemorrhage.
Harvey emphasizes the overarching need to address the challenges of obstetric hemorrhage through collaborative, multidisciplinary solutions, including planning teams with members with a variety of licensure types and specialties. Such wide-ranging representation may help alleviate potential delays in one area of the hospital that may affect clinical decision-making during an emergency situation and thus place the patient at increased risk for negative outcomes.
Other articles in the journal’s symposium address:
- Significant physiological changes during pregnancy that have implications for critical care management
- Cardiac disease and risks
- Sepsis
- Preeclampsia and other hypertensive disorders of pregnancy
- Pulmonary edema
- Amniotic fluid embolism
AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles and columns of interest to critical and progressive care clinicians.
Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.
About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses, the journal has a circulation of 4,845 and can be accessed at http://acc.aacnjournals.org/.
About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the U.S. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.
American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000 www.aacn.org; facebook.com/aacnface; twitter.com/aacnme
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