High Dependency Care

Admission criteria to Obstetric High Dependency Unit (HDU)

In most Scottish units, Maternal Critical Care is provided in a high dependency area on labour ward.

In larger hospitals, this will be a dedicated Obstetric High Dependency Unit.  However, depending on the stage of labour and other factors, patients might be cared for in a delivery room or a private room dedicated to women who experienced a fetal loss.

The care ratio between midwives and patients in HDU should be  2 midwives:1 patient.

There are definite advantages in keeping obstetric patients in the HDU of the maternity unit including continuity of antenatal and postnatal care, continued skilled interpretation of fetal monitoring , knowledge base of obstetric care and the ability to keep mother and baby together. However maternal safety is paramount and transfer to ICU or other high dependency care must be undertaken if the balance of risks favours this.

In order to provide the same standard of care throughout Scotland the following criteria should be used as a  guide for admission to an obstetric HDU. This is not an exhaustive list and the decision for admission is left to the discretion of the medical team.

1.    Conditions that require observations, monitoring and treatment that cannot  be safely provided in a ward or other intermediate care area

  • Severe renal impairment
  • Severe electrolyte disturbance
  • Severe hepatic impairment
  • Severe coagulation disorder
  • Pathology requiring specialist review
  • Complex pain treatments
  • Severe endocrine dysfunction
  • Diabetic ketoacidosis
  • Thyrotoxicosis
  • Sepsis (life threatening organ dysfunction caused by infection)
  • Super morbidly obese women who received general anaesthesia

2.     Patients requiring respiratory support

  • >30% oxygen or >2l/min oxygen
  • Physiotherapy to aid expectoration

Examples:

◦ Pneumonia

◦ Moderate Asthma

◦ Fibrosis

◦ Pulmonary Oedema

3.    Patients with compromised  cardiovascular system

  • Post partum haemorrhage if

◦ > 2500 mls

◦ > 1500mls and cardiovascular unstable

◦ > 1500mls and high risk of rebleeding

◦ intrauterine balloon and/or vaginal packs in situ

  • Congenital or acquired cardiac co-morbidity
  • On an infusion for blood pressure control (eg.labetalol, hydralazine, GTN etc.)
  • Continuous ECG monitoring
  • Intra-arterial BP monitoring
  • CVC used for fluid management and CVP monitoring
  • CVC for intravenous access only

4.       Patients requiring support of neurological system

  • Magnesium infusion for

◦ severe pre-eclampsia

◦ eclamptic fit

◦ neurological protection for premature baby

  • Prolonged or frequent seizures requiring intervention