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Table 2 The key features of the three video vignettes used as triggers for the focus groups

From: What factors influence midwives to provide obstetric high dependency care on the delivery suite or request care be escalated away from the obstetric unit? Findings of a focus group study

  Scenario 1 Scenario 2 Scenario 3
Clinical Picture Postnatal mother with severe pre eclampsia at 30/40 gestation. Vaginal birth 90 min previously. Neonate transferred to neonatal unit Postnatal mother who has recently had a primary PPH. On-going management in progress after the initial emergency treatment. Neonate with mother. Woman 32/40 pregnant with comorbidities (type 2 diabetes and ventricular septal defect repaired in infancy). Raised BMI. Admitted with mild chest pain and low oxygen saturations (88–90%) in air.
Intravenous magnesium sulphate / intravenous anti- hypertensives in progress Blood transfusion in progress. Continuous ECG in progress
Uncontrolled hypertension CVP line in situ due to poor peripheral access Requiring 4 L/min oxygen, via face mask to maintain oxygen saturations at 97%
Hyperreflexia, 4 beats of clonus Hourly CVP readings requested to guide fluid replacement Stable vital signs whilst patient has oxygen therapy in progress, (but at risk of deterioration)
Headache Stable pulse and blood pressure. Lochia within normal limits. Normal CTG, normal fetal movements.
Blood picture shows HELLP syndrome Reduced urine output Differential diagnosis of cardiac event or pulmonary embolism
Overall, presents with an unstable clinical picture in view of uncontrolled severe hypertension, blood picture and neurological examination findings. Overall, relatively stable condition, but requiring CVP monitoring. Currently stable with oxygen therapy in progress but potential for deterioration
Workload Moderate. All women on the Delivery Suite are in labour – mainly low risk. High. All but one of the Delivery Suite rooms are occupied however, anticipated that three women will be transferred home / to the post natal ward in the next hour. Low to moderate. There are empty rooms, mainly low risk women in labour.
Staffing Correct number and grades of midwives on duty for the maternity unit in question All band 6 midwives with one band 7 midwife coordinating. One band 6 midwife off sick. All band 6 midwives (except one newly qualified midwife) on duty with one band 7 midwife coordinating. No staff off sick.
  1. Key:
  2. CTG Cardiotocograph
  3. ECG Electrocardiogram
  4. CVP Central Venous Pressure
  5. HELLP Haemolysis, Elevated Liver enzymes, Low Platelets
  6. PPH Post Partum Haemorrhage