Role of the anaesthetist in obstetric critical care

The anaesthetist plays a key role in the management of high-risk pregnancies, and must be a member of the multidisciplinary team that is required to care for the critically ill obstetric patient. Anaesthetists are trained in advanced life support and resuscitation. They are experienced in the management of the critically ill, and provide anaesthesia, sedation and pain management. The obstetric anaesthetist should undertake education of medical and midwifery staff in the early recognition, monitoring and treatment of the sick mother, resuscitation training, running 'skills drills' for emergency simulations, risk management and audit of maternal morbidity on the labour ward. To date, there is little evidence to inform the anaesthetic management of the critically ill obstetric patient; most recommendations and guidelines are based on the management of non-obstetric, critically ill patients. Management must be adapted to encompass the physiological changes of pregnancy. Evidence-based guidelines on management of the critically ill woman with specific obstetric conditions are also lacking.