Service organization: Hospital and departmental

Introduction The evolution of critical care medicine started in the 1960s and guidelines for the design and staffing of critical care units were developed further during the following decades. The purpose of maternal high dependency or critical care is to provide specialized care to the sick parturient both antenatally and postpartum. The critically ill parturient is unique in that the needs of both the mother and fetus have to be considered. Delivering high-quality care to this high-risk group can be challenging and involves a multidisciplinary approach. The needs of such patients can be quite complicated and may require input from obstetric, anesthetic, medical, and surgical teams. Although detailed guidelines for parturients in need of critical care are sparse, several national professional organizations have made recommendations pertaining to the role of critical care in the management of the obstetric patient [1]. Since the early 1990s, a multitude of reports, mainly retrospective with small sample sizes, has provided descriptive analyses of intensive care utilization by critically ill parturients. Such reports reflect significant variations in definitions of major morbidity, patient populations, unit design, admission criteria, usage rates, and outcomes [2–8]. Differences in access to healthcare, nursing policies, hospital settings, and management protocols add to the observed variations, which make comparisons of prognostic factors, standards of care, and recommendations for improvement difficult. Therefore, proposing maternal morbidity as an indicator for quality measures of maternal services is hampered.

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