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Hospitals should have mechanisms to promote early identification of the emergency surgical patient with diabetes.

Hospitals should have clinical guidelines including:¹³⁴

• involving patients in the management of their own diabetes. Most diabetic patients are experts in managing their own disease, and the management of the emergency diabetic surgical patient can usually be undertaken with only minor modifications in the patient’s usual regime.
• emergency surgery patients with diabetes should be assessed for multimorbidity and...

A multidisciplinary team approach is highly recommended, typically involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^{137,138,139,140}

Surgery should be undertaken where neonatal and paediatric services are readily available whenever possible.¹³⁷

Fetal heart rate monitoring should be available and local policies should outline its use taking into account fetal viability, the physical ability to perform it and availability of a healthcare provider able to intervene for fetal indications.^{137,138,141,142}

Informed consent for the surgical procedure should include consideration of fetal wellbeing and the possibility of caesarean delivery.¹³⁹

Equipment for maternal positioning and uterine displacement should be available.^138,142

Local guidance, including provision for training and audit, should be available for:

• aspiration prophylaxis^138,142,143
• difficult airways and failed intubation^{94,139,144,145}
• cardiopulmonary resuscitation in the pregnant woman and perimortem caesarean delivery^{136,141,144,146}
• anti-D immunoglobulin administration^136,147
• major haemorrhage^1...

In the event of a maternal death the case must be reported to the coroner and should be reported to MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). Medical devices such as intravenous lines and tracheal tubes should not be removed prior to post mortem examination.¹⁴⁶

Hospitals must have local policies in place for the identification, support and safeguarding of vulnerable adults.^2,154