A Pilot Project of Establishment of a Maternal Special Care Bed in a Tertiary Hospital

Abstract Description

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Authors (including presenting author) :

Hui SYA(1), Ng SM(1), Tam WH(1)(2)

Affiliation :

(1)Department of Obstetrics and Gynaecology, Prince of Wales Hospital, (2)Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong

Introduction :

With the ageing maternity population and increasing complexity of coexistent diseases, there is a raising need for maternal critical care worldwide, with the aim of reducing maternal morbidity and mortality. In May 2018, a pilot project was initiated in the Prince of Wales Hospital, a “Maternal Special Care Bed” (“MSCB”) within the delivery suite was designated to provide level 1 and level 2 critical care, managed by a multidisciplinary team consisted of trained midwives, obstetricians and anaesthetists with additional training in critical care. The aim is to ensure that critically ill pregnant or postpartum women would receive up-to-standard care for both their pregnancy related and critical conditions.

Objectives :

(1) to review the occupancy of the MSCB; (2) the level of care provided by MSCB; (3) the disease spectrum cared within the MSCB.

Methodology :

A retrospective review was carried out for the first six month period after the establishment of the MSCB service. For the classification of critically ill patients, level 1 is defined as patients at risk of deteriorating, or those stepping down from higher levels of care, or those in need of additional monitoring or input from critical care team; level 2 is defined as patients requiring more detailed observation or intervention including support for a single organ system or extended post-operative care, or those stepping down from higher levels of care.

Result & Outcome :

From 21 May 2018 to 20 November 2018, the overall bed occupancy rate is 82.2%. A total of 144 parturients were admitted to MSCB, 59.7% (n=86) received level 1 care and 40.3% (n=58) received level 2 care. The top 5 conditions leading to MSCB admission were hypertensive disorders complicating pregnancy (n=77), massive postpartum haemorrhage (n=30) and glucose and electrolytes disturbances (n=15), severe sepsis (n=9) and cardiac diseases in pregnancy (n=6).