The Critical Care Issue (32:3) addresses a variety of topics for the reader. The Perinatal section focuses on care of the woman who requires critical care during pregnancy. Providing care to this unique population and their families presents challenges to us as a society, institutions within which care is delivered, and to clinicians on the front lines.
"Maternal Morbidity and Mortality in the United States (US): Classification, Causes, Preventability, and Critical Care Obstetric Implications" is covered by Troiano and Witcher. There has been a steady rise in US pregnancy-related deaths and severe maternal morbidity over the last 3 decades. It is estimated that approximately 50% of maternal deaths are preventable. National, multidisciplinary, collaborative efforts are required to effectively address this problem. Concepts presented include classification, causes, and preventability.
Baird and Martin address standards for designations of levels of maternal care that are complementary to, but distinct from, neonatal levels of care in "Framework for Critical Care in Obstetrics." This article utilizes key components of program development including environment, scope, model, education and training, maternal transport, and unique aspects of care for women who become critically ill during the peripartum period. Collectively, these provide a framework within which this specialized level of care is provided in an obstetric unit.
As teams implement early warning signs of maternal compromise, it is anticipated that women will be admitted to intensive care status earlier and may require electronic fetal monitoring (EFM). In the article "A Standardized Approach to Electronic Fetal Monitoring in Critical Care Obstetrics," Cypher addresses questions that frequently arise when providing fetal assessment in a critically ill woman. This topic has not been frequently addressed in the literature, and Cypher provides detailed considerations for interpretation and management, including EFM during surgical procedures, perimortem cesarean birth, and in women who have irreversible loss of brain function.
A majority of pregnancy-related deaths in the United States occur in the postpartum period, and many of these deaths are preventable. Bingham, Suplee, Morris, and McBride explore this in-depth in "Healthcare Strategies for Reducing Pregnancy-Related Morbidity and Mortality in the Postpartum Period." Data are reviewed that provide the foundation for evidence-based recommendations. Six healthcare strategies for reducing postpartum maternal morbidity and mortality are described. The potential impact of implementing these strategies in an equitable manner by all providers to all women is discussed. We encourage the reader to review all perinatal columns: Legal and Risk Management and Expert Opinion.
Critical care of the newborn infant is multifaceted and requires a multidisciplinary approach. In the neonatal section of the journal, 4 articles are featured in the print version of the journal, with an additional article published online. The first is from Nathan Sundgren and colleagues. In this article, the authorship team highlights the importance of optimal systems for improving interdisciplinary communication when summoning neonatology to high-risk deliveries. Two articles focus on stress and coping. One from the perspective of parents, specifically fathers, authored by Craig Garfield et al, and the other from the perspective of nurses, authored by Britan Moore and Kriston Schellinger. Terri Marin et al report on biomarkers for acute kidney injury, an important topic in neonatal nursing. And, finally, Kim Kamphorst et al report on their findings from an observational study of parental presence and activities in a Dutch neonatal intensive care unit. This article is published online in the Journal of Perinatal & Neonatal Nursing (JPNN).
As always, our columnists, Sara Rostas and Nicole O'Connor and Joan Smith, have each provided a thought-provoking column for our consideration and reflection. Sara has started a new feature within her Pharmacy column called "Essentials for the Neonatal Nurse" and reports on SMOFlipid. Nicole O'Connor and Joan reports on an innovative ECMO (extracorporeal membrane oxygenation) staffing model to reduce harm. Terese Verklan shares Parting Thoughts with us on the next generation of nurses.
As always, thank you for reading JPNN. Please reach out to us with any thoughts or suggestions for the journal. Please also note that we have 3 great topic areas planned for forthcoming issues of the journal: innovations in clinical practice, disparities and access to care, and emergency and disaster readiness. It's never too soon to begin preparation of a manuscript for one of these topics-we welcome your submissions!
-Nan H. Troiano, MSN, RNC-OB, NE-BC, C-EFM
-Suzanne McMurtry Baird, DNP, RN
Perinatal Guest Editors
-Katherine E. Gregory, PhD, RN
Neonatal Editor