A National Survey on Critically Ill Obstetric Patients Care Centers

Maternal mortality remains a pressing global health challenge, with stark regional disparities persisting despite advancements in care. China has made remarkable strides by reducing its maternal mortality rate from 1500 per 100,000 in 1949 to 17.8 per 100,000 in 2019, achieving the Millennium Development Goals ahead of schedule.1 This progress stems from enhanced delivery care quality and public health initiatives, yet challenges endure as China aims for a further reduction to 12.0 per 100,000 by 2030 under the Healthy China 2030 Plan.2 The management of critically ill obstetric patients is pivotal to this goal, directly influencing maternal survival. Strengthening critical care centers—now over 3000 nationwide—serves as the last line of defense, but gaps in infrastructure, training, and regional equity demand urgent attention. The study involved human participants, and the protocol was approved by the Third Affiliated Hospital of Guangzhou Medical University (IRB (2024)-154). All participants provided informed consent before participation. Recent national trends underscore the evolving landscape of obstetric care. Between 2021 and 2023, total deliveries in surveyed hospitals declined from 1,135,906 to 1,052,303, mirroring China’s broader fertility drop from 10.62 million births in 2021 to 9.02 million in 2023.3,4 This decline, evident across regions (Supplementary Fig. 1, https://links.lww.com/MFM/A106), reflects demographic shifts and policy impacts, such as the waning effects of the two-child policy since 2017. General hospitals experienced a milder drop compared to specialized ones, highlighting resource disparities. With fertility rates projected to fall short of population maintenance by 2050 in 76% of countries, including China,3 sustaining robust obstetric services is imperative. Attracting young physicians to the field, where 64.4% (298/463) of practitioners are aged 31-50 and 91.8% (425/463) are female, is essential for long-term vitality (Supplementary Table 1, https://links.lww.com/MFM/A106). Critical care for obstetric patients must prioritize early intervention and multidisciplinary approaches to address leading causes like hypertensive disorders of pregnancy (69.2%, 14,294/20,646) and obstetric hemorrhage (26.1%, 5386/20,646) (Supplementary Fig. 2A, https://links.lww.com/MFM/A106). Non-obstetric factors contribute to 55.4% of ICU admissions, emphasizing the need for integrated care beyond traditional obstetrics (Supplementary Fig. 2B, https://links.lww.com/MFM/A106).5,6 Encouragingly, 94.8% of hospitals have multidisciplinary teams (MDTs), with 89.0% of physicians trained in both obstetrics and ICU, and 36.7% rotating through ICU for an average of 3.5 months. However, only 34.6% of hospitals have dedicated Obstetric Intensive Care Units, a shortfall that hampers specialized response, particularly for indirect causes of mortality, which rose from 28.7% in 2000 to 54.1% in 2018.7 Regional and institutional variations further complicate the picture. While 77.3% of critically ill patients originate in-hospital, 22.7% are transfers—87.6% from within the city and 12.4% from outside (Supplementary Fig. 2C, https://links.lww.com/MFM/A106). The low annual referral rate to higher-level hospitals (3.5 cases, or 5.9%) reflects improvements from initiatives such as the five-color risk management program and tiered referral systems.8 Yet, specialized hospitals boast higher proportions of graduate-educated physicians (31.2% vs. 18.9%) and OICU (59.7% vs. 29.5%), while general hospitals lead in ECMO capabilities (37.8% vs. 16.9%) (Supplementary Table 2&3, https://links.lww.com/MFM/A106). It is time to recognize critical care infrastructure as a core pillar of maternal health in China. The predominance of in-hospital cases indicates progress, but external transfers highlight inequities in lower-tier facilities, often in less developed regions. To align with Sustainable Development Goals and Healthy China 2030, we advocate for mandating OICU construction nationwide, with dedicated funding and evaluation frameworks. Leadership in these centers should emphasize MDTs supported by ICU rotations and training. Gender-specific considerations, given the female-dominated workforce, could enhance retention and innovation. Our experiences underscore that technology alone—such as ECMO—does not suffice without holistic, patient-centered care. Balancing technical advancements with leadership training, as seen in successful models, will foster resilient systems. National bodies must prioritize equitable resource allocation, especially in underrepresented regions such as the west and northeast, to prevent avoidable deaths. By investing in human resources, infrastructure, and interdisciplinary collaboration, China can further reduce maternal mortality and set a global example. Funding This study was supported by the National Key R&D Program of China (2022YFC2704500), the Guangdong Basic and Applied Basic Research Fund (Guangdong-Shenzhen Joint Fund) (2021B1515120070). Conflicts of Interest None. Data Availability Data will be provided upon reasonable request to the corresponding author. Editor Note Dunjin Chen is a member of the Editorial Board of Maternal-Fetal Medicine. The article was subject to the journal’s standard procedures, with peer review handled independently of this editor and the associated research groups.