Clinical characteristics and outcomes of obstetric patients requiring ICU admission: a 5-year retrospective review

Abstract

To investigate the clinical characteristics and outcomes of obstetric patients requiring intensive care unit (ICU) admission in a tertiary hospital. Methods: We retrospectively analyzed the clinical data of all pregnant/postpartum patients admitted to a tertiary ICU from January 2014 to December 2018. Result: One hundred and thirty-three obstetric patients were analyzed. Most patients (114, 85.7%) were admitted postpartum, and 57.9% (n = 77) of ICU admissions were from obstetric causes. The most common obstetric cause of admission was obstetric hemorrhage (32, 24.1%), followed by pregnancy-associated hypertension (25, 18.8%). The most common non-obstetric cause of admission was cardiac disorder (16, 12%). Ninety-eight patients (73.7%) came from non-urban areas. We compared patients from non-urban areas versus urban areas: Acute Physiology and Chronic Health Evaluation (APACHE) II, 8.35 ± 3.14 versus 6.43 ± 2.59 (P = 0.002); standard prenatal care, 62.3% versus 90.3% (P = 0.004); transferred from another hospital, 25.5% versus 2.9% (P = 0.004); blood transfusion, 48% versus 22.9% (P = 0.010); plasmapheresis, 11.2% versus 0% (P = 0.039); multiple-organ dysfunction syndrome, 30.6% versus 11.4% (P = 0.026); mortality, 10.2% versus 2.9% (P = 0.176). Total maternal mortality in ICU was 8.3% (n = 11). The fetal mortality rate was 10.9% (n = 15). Conclusions: A multidisciplinary team approach is essential to improve the management of obstetric hemorrhage, hypertensive disorders and cardiac disorders, which may in turn significantly improve maternal outcomes. Health disparities existed between patients from non-urban versus urban areas: the former was sicker at admission, received less standard prenatal care, were more frequently transferred from other hospitals, received more interventions, developed more complication, and suffered a higher rate of maternal mortality.

A study of critically ill obstetric patients admitted to intensive care unit of a tertiary care hospital

“…15 Qureshi et al also concluded that MAP accounted for one third of ICU admissions because of extensive blood loss. 3 In a Chinese study by Zhang M et al 13 16 cases of ICU admission were due to placenta increta. Their study was over four years and analyzed one hundred and thirty three patients needing ICU admission.…”

“…Cardiac diseases were the cause of admission to ICU in 12% cases in a study conducted in China. 13 Improvement in medical technology has increased the survival of patients with congenital heart diseases. However, the physiological burden of pregnancy can unmask the compromised heart function in certain cases especially if they have not received proper preconception and antenatal care.…”