Critically ill obstetric patients in the intensive care unit

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Abstract

We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors (P<0.05). The commonest cause of intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.

Introduction

Maternal death is a particularly tragic event because pregnant women are usually young and healthy.1 Despite therapeutic advances during this century, deaths of pregnant women remain an important public health problem.[2], [3] According to the report of the Ministry of Health of the Turkish Republic, the pregnancy-related mortality ratio was 49.2 per 100 000 live births in 1998.4 In this report, the leading causes of pregnancy-related death were hemorrhage (30.3%), hypertensive disorders of pregnancy (15.5%), infections (9.6%), and complications due to abortion (4%).4 In our institution, the pregnancy-related mortality ratio between 1991 and 1996 was 80 per 100 000 live births.5

The pregnant patient with medical complications represents a unique challenge to physicians in the intensive care unit (ICU) and often requires the expertise of several subspecialities.6 Some centers have obstetric ICUs but most use general ICUs to manage critically ill obstetric patients.[2], [3], [4], [7], [8] One indicator of maternal morbidity is transfer to an intensive care unit.6 Relatively few studies concerning obstetric ICU patients have been published; Scarpinato et al.9 identified a serious lack of knowledge on obstetric critical care and called for increased reporting of data.

The aim of this study was to review all obstetric patients admitted to our intensive care unit over the last five years to determine the causes and outcomes of ICU admission and the frequency and causes of maternal mortality.

Section snippets

Materials and methods

We retrospectively analyzed all obstetric patients who were admitted to ICU for more than 24 h between June 1995 and June 2000.

The records of 125 obstetric patients were reviewed and the following data were obtained: maternal age, gestational age, mode of delivery, presence of coexisting medical problems, duration of ICU stay, ICU admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, arterial

Results

During the study period 4733 patients were admitted to the ICU, 125 of whom were obstetric patients, representing 2.64% of all ICU admissions, and 0.89% of deliveries in our university hospital. Fifteen obstetric patients had been transferred to our ICU from other hospitals. The mean age for all obstetric ICU admissions was 28±6 years (range, 16–44 years). There were no significant differences between survivors and non-survivors in age or gestation (Table 1). The majority of obstetric patients

Discussion

Maternal mortality is the most extreme adverse effect on the health of pregnant women. Complications during pregnancy or in the post-partum period can be life-threatening and require intensive care.[1], [2], [3] An intensive care unit offers the opportunity to improve patient care. Close observation in the intensive care unit allows problems to be detected earlier and in some cases, the complications to be prevented so the patient can recover more quickly.7 Care of critically ill patients can

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