The Impact Of An Obstetrician-Led, Labor Ward Critical Care Unit: A Prospective Comparison Of Outcomes Before And After Establishment

Objective: To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa.Methods: Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality.Results: In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure (p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group (p = 0.01).Conclusion: The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality.