In response to the publication of the MBRRACE-UK report1, Dr Liam Brennan, President of the Royal College of Anaesthetists (RCoA) stated in December:
“Maternal death in the UK is fortunately a rare event but when a mother does die in hospital, anaesthetists and intensive care (critical care) specialists have often been involved either as part of a resuscitation team or in providing pain relief and multi-organ support in the final days of life. This important report assessed the care of 144 women who received critical care prior to their death between 2009 and 2014. It found that even amongst the women who die, many received a high standard of care.
“There are however, important lessons to be learned when mothers do die in hospital. Early recognition of critical illness and the prompt involvement of senior clinical staff remain key factors to achieving good outcomes. With critical care units in the UK running close to full capacity and delays to admission whilst beds are being found commonplace, critical care support can be initiated across multiple hospital settings. Obstetric anaesthetists are therefore well-placed to work flexibly and in partnership with critical care colleagues to provide initial resuscitation and stabilisation whilst bed management takes place. Delays caused by bed pressures are not a reason to postpone life-saving critical care treatments.
“The report also makes recommendations on transfers of sick mothers between hospitals and draws lessons from the women who died in the Swine flu epidemic in 2009.
“For hospital teams to learn from tragic cases, it is essential that when critical care staff are involved in a maternal death, they must be included in the case reviews and serious incident investigations that follow. It is disappointing to learn from the report that this does not always take place.”
This is the first maternal confidential enquiry report to include a chapter on critical care since 2011 and it contains lessons which are relevant to all obstetric anaesthetists and critical care doctors.
With anaesthetists being the largest single specialty group of doctors in hospitals and playing a critical role in the care of patients before, during and after surgery, they are frequently relied upon to provide high quality critical care. Over two-thirds of hospital in-patients come into contact with an anaesthetist at some stage during their admission.
1. Saving Lives, Improving Mothers’ Care. MBRRACE-UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK http://bit.ly/1wVNPqL