P72 Caring for critically ill women in obstetrics in ireland: 2014–2016

Background The provision of safe maternal critical care requires resource planning and development of relevant competencies among healthcare professionals. However, there are no national data recording the activity of higher levels of care in obstetrics. The objective of this study was to establish the incidence, location of care and underlying maternal morbidity associated with Critical Care in Obstetrics in Ireland. Methods For 2014–2016, 15 Irish maternity units provided anonymised data on pregnant or recently pregnant women requiring Level 2 Care (invasive monitoring or support for a single failing organ system) or Level 3 Care (requiring mechanical ventilation alone or support of two or more organ systems). Morbidities were classified using both the World Health Organisation and the National Perinatal Epidemiology Centre definitions of severe maternal morbidity. Results Among 124,135 maternities, 900 women required Level 2 Care (7.3 per 1,000 maternities) and 61 women required Level 3 Care (0.5 per 1,000 maternities). While Level 3 Care was provided in an ICU facility, the location of Level 2 Care varied by maternity unit - the smaller the unit, the greater the utilisation of the ICU. Respectively, hypertensive disorders and obstetric haemorrhage affected 54.2% and 27.3% of women requiring Level 2 Care and 11.5% and 44.3% of women requiring Level 3 Care. The need for higher level of care was not predictable in approximately half of the women. All woman requiring Level 3 Care and 37.1% of women requiring Level 2 Care met the criteria of organ dysfunction as specified by the national clinical audit of severe maternal morbidity. Conclusion A significant number of women requiring Level 2 Care do not experience organ dysfunction as their clinical needs were identified and treated before organ dysfunction occurred. Thus, there are limitations of existing classification systems on severe maternal morbidity in quantifying level of care provided. The variation in location of Level 2 Care has implications for staff training in both maternity units and ICU.