Acute Care Edinburgh

Maternal critical care: identifying at-risk women and understanding the short and long term consequences of critical illness in pregnant or recently pregnant women.

Funder: Obstetric Anaesthesia Association. Value: £48,262

About 1 in 100 women experience life-threatening illness (‘critical illness’) during pregnancy or childbirth. Recent reports suggest that the care that critically ill pregnant women receive could be improved by developing ways to identify women at risk of critical illness earlier during pregnancy or childbirth, improving how doctors and nurses provide care and having specialised pregnancy specific support for survivors. However, we have little research to guide these improvements in care. Our project aims to provide high quality data to inform development and implementation of these recommendations.

We aim to measure the number of pregnant women who need critical care, identify those women at highest risk of needing critical care, and report the short and long-term health consequences of surviving critical care for pregnant women and their babies.

We will use routinely recorded and linked clinical datasets to answer our research questions.

In Scotland, every pregnant woman has clinical information recorded about her pregnancy and its outcome recorded in national databases. This pregnancy information will be linked to a critical care database, which contains additional information about those admitted to critical care. This combined dataset will then be linked to other sources of information, including mental-health admissions and pharmacy prescriptions. This final dataset will be anonymised so that researchers cannot identify individual women. The data will be analysed in a secure environment, which only the research team can to access. 

We will calculate how frequently women need critical care across Scotland. We will compare women who need critical care with those who do not in order to identify factors that could predict which women are at highest risk of needing critical care. We will take account of important factors such as the mother’s socioeconomic status, weight, age and previous health problems. We will then compare a range of short and long-term outcomes that affect mothers and their babies including death, hospital length of stay, pregnancy-related complications, and hospital readmission.

Our project will help us i) find out how often pregnant women need critical care; ii) identify risk factors for critical illness, leading to better recognition of women who may need critical care; iii) identify the major problems that women and their babies experience after surviving critical care which will enable researchers/health workers to develop targeted interventions/services to improve care; and iv) provide important data to improve maternal critical-care audits.

We have a strong team and expert advisory panel in order to make sure our findings influence care in the NHS. We have worked with a woman who has survived critical illness after pregnancy to develop this project. Our findings will be used by obstetricians, obstetric anaesthetists and midwives to better recognise critically ill women and ensure adequate numbers of staff are trained to meet this demand; by critical care doctors and nurses to guide improvements in multidisciplinary working, the national maternal critical care audit and follow-up for women who survive critical care; and community healthcare staff and critical illness survivors and families.

For further information please contact: Dr Nazir Lone