Organizing an obstetrical critical care unit

1. Organizing An Obstetrical Critical
care Unit
Prof. M.C.Bansal.
MBBS.MS. MICOG. FICOG.
Founder Principal & controller;
Jhalawar Medical College And Hospital,
Jhalawar.
Ex. Principal & Controller ;
Mahatma Gandhi Medical College And Hospital,
Sitapura, Jaipur.

3. Why An obstetrical ICU –Needed ?
• Pregnancy alters maternal physiology with respect of all body
organs and systems.
• In addition providing specific care to mother, we have to consider
the needs of unborn child , most likely to be influenced and
affected by mother’s current health status.
• Pregnancy as well delivery poses risk of an extra and newer health
problems and unwanted complications having adverse and life
threatening effect on both mother and child.
• Addressing this complication prone population requires specific
expertise care , not only obstetrician but also nursing and additional
ancillary staff who can provide cardio -respiratory support or
pharmaceutical intervention.
• Hence it is clear the need to develop multidisciplinary approach to
provide optimal care ,under single roof, to critically ill obstetrical
patients.
• Current reports , from obstetrical tertiary care centers, accepting
referred cases , that 0.5-1% of their admissions do require an
intensive care ---there by decreasing their mortality by 10 folds.

4. Criteria for admission in ICU
with decompensated
function of

5. Staff pattern to help the skilled and
experienced obstetrician IN ICU

6. Staff In ICU
• Skilled and experience obstetrician as consultant.
• Senior resident (ob & gy Discipline ) on floor duty .
• Intensivists .
• Respiratory Therapist.
• Trained and skilled Nursing staff.
• Clinical Pharmacist .
• Ancillary Staff.
Multidisciplinary team shall coordinately work and
provide, protocol driven care , assist in critical care
decision taking ---going ahead with the processes
along with having common goal to provide optimal ,
quality and evidence based care to the critically ill
patient .

7. Charecterstics and job chart of Team
Members---
• A. Obstetrician---Head of the team , should be
skilled obstetrical care provider along with the
skilled knowledge of maternal – fetal Medicine.
His skilled training in this field will help in
assessing physiological changes in pregnancy in
body systems and their effect in utero---
compromise / compensation and complication to
fetus that can jeopardize the well being of fetus
and mother.

8. Characterstics Sand job chart of Team
Members---
• B. Intensivists-- physician---
Whose day to day work is in the management
of critically ill patient’s vital sign care– His skills
help in early identification of forth coming
complications and timely management on war
footling , in reducing fetal and maternal mortality
and late sequelies , reduce cost factor and
hospital stay too.
Time to time he may need immediate help of
specialists and super specialists of other medical
disciplines as and when a new problem develops.

9. Characterstics Sand job chart of Team
Members---
C . Nursing Staff—
High risk obstetric nursing care requires a
confident, companssionate , skilled and well
trained nurse willing to under take complexities
and challenges of higher acuity care.
Staffing pattern should be should be 1:1 nurse
to patient ratio.
At times it may be 2: 1 in cases of unstable
patients.
Her education and level of skill development ---
as per chart in next slide

10. Obstetric ICU nurse --- Qualification

11. Job Chart Of ICU-- Nurse
• Patient’s bed side sitting --- general nursing care
of critically ill patient along with cardiopulmonary
monitoring .blood draws .medicine
administration .fetal monitoring with ETCG .
Optimizing patient’s position , surveillance for
symptoms and signs of Pre Term labour .
• She also helps to foster communication between
obstetrician , Intensivists and family members
who are waiting for time to time information
about patient’s condition as the are naturally
anxious and concerned.

12. Other Staffing
• In order for appropriate clinical services to be provided
to the critically ill patient in ICU unit , ICU must have
personnel whose main focus is on administrative
details.
• It should be based on the guide lines developed by task
force of American college of critical care medicine and
its society.
• ICU unit must have designated medical and nursing
directors who shall be responsible for assuring
standard, appropriate triage through enforcement of
patient admission , care and discharge criteria.
• These personnel will also promote continuing
education, update the skills of clinical staff, improve
and ensure maintenance of quality care being
provided to patient.

13. Other staffing---
• Implementing technical advancements ,
Maintenance of care protocols and all other facilities to
improve the patient care . Maintain safety against
hospital born cross infection.
Other than these . Nutritional services, cleanliness
disinfection, psychological support to patient and her
relatives,
Out patient / home services through spiritual / social
agencies also offer additional support to patient and
relatives --- help and assist with emotion stress of ICU
environment, quick recovery from disease process and
even potential end to life.

14. Flow charts and proto calls for
some critical conditions

43. Double click on next slides to open the PDF