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Maternal levels of care

Maternal levels of care
Level Title Maternal health Hospital capabilities Anesthesia staffing Modified World Health Organization Patients*
Birth center Birth center Low risk Not applicable None None
Level I Basic care Low to moderate risk

Limited obstetric ultrasound

Blood bank
Anesthesia provider readily available at all times Modified World Health Organization class I
Level II Specialty care Moderate to high risk

Computed tomography scanning/magnetic resonance imaging

Maternal echocardiogram

Nonobstetric ultrasound
Anesthesiologist readily available at all times Modified World Health Organization class I or II
Level III Subspecialty care More complex maternal, obstetric and fetal conditions

Interventional radiology

In-house capability of all blood components
Board-certified anesthesiologist physically present at all times Modified World Health Organization class I or II, some III
Level IV Regional perinatal health center Most complex maternal conditions

ICU care with Maternal Fetal Medicine comanagement

Cardiovascular surgery, ECMO, and transplant capabilities
Board-certified anesthesiologist with obstetric anesthesia fellowship or experience in obstetric anesthesia physically present at all times Modified World Health Organization class I, II, III, or IV

ECMO: extracorporeal membrane oxygenator; ICU: intensive care unit.

* The addition of the Modified World Health Organization classifications into the Maternal Levels of Care is an extrapolation based upon Drs. Meng and Arendt's experience, and is not a direct recommendation from the American College of Obstetricians and Gynecologists, Society of Maternal–Fetal Medicine, or Modified World Health Organization.
From: Meng ML, Arendt KW. Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations. Anesthesiology 2021; 135:164. DOI: 10.1097/ALN.0000000000003833. Copyright © 2021 American Society of Anesthesiologists. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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