Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001 - 2010

Abstract

BackgroundICU admission is uncommon among obstetric patients. Nevertheless, the epidemiology of ICU utilization is considered to be a useful proxy for study of severe maternal morbidity and near-miss events. However, there is paucity of population-level studies in obstetric patients in the United States.MethodsThe Texas Inpatient Public Use Data File and state-based reports were used to identify pregnancy-associated hospitalizations and those involving admission to ICU (n = 158,410) for the years 2001 - 2010. The clinical characteristics, outcomes, and the overall incidence and temporal trends of ICU admission were examined and stratified analyses of pregnancy outcomes were performed in specific categories of pregnancy-associated hospitalizations. In addition, ICU utilization among hospitalizations with maternal complications and organ dysfunction was evaluated.ResultsChronic comorbidities (9.7%) and presence of organ dysfunction (6.2%) were uncommon among ICU admissions, with 26.5% having high severity of illness. The incidence of ICU admission was 39.0 per 1,000 pregnancy-associated hospitalizations-years. Marked variability was found in ICU admission both across pregnancy outcomes (ranging from 0.6 per 1,000 abortions-years to 85.9 per 1,000 stillbirths-years) and categories of pregnancy-associated hospitalizations (ranging from 32.1 per 1,000 delivery hospitalizations-years to 144.8 per 1,000 postpartum hospitalizations-years). The incidence of ICU admission rose 68% among pregnancy-associated hospitalizations and for all examined subgroups, except abortion. Preeclampsia/eclampsia (23.3%) and obstetric hemorrhage (6.9%) were the most common maternal complications among ICU admissions. Four hundred fourteen women (0.3%) died, while 97.6% were discharged home.ConclusionsThis study documents the highest incidence of ICU utilization in obstetric patients in the US to date. The findings suggest low threshold for obstetric ICU admissions in the state and do not support comparative use of ICU utilization as surrogate measure for populations’ burden of severe maternal morbidity and near-miss events. Nevertheless, the demonstrated tremendous heterogeneity in ICU utilization across examined subgroups identifies new high-risk groups of obstetric patients that would benefit from heightened clinician vigilance and timely ICU triage and care. Further studies are needed to inform reduction in avoidable variability in ICU utilization to both enhance maternal, fetal, and neonatal outcomes and to improve resource allocation.

Maternal Mortality in Brazil: Proposals and Strategies for its Reduction

“…9 Associated with the failure to recognize the signs of severe complications and delayed access to adequate care, a considerable part of maternal deaths that occur even at the tertiary level could be avoided through prompt care in obstetric intensive care units (ICUs) or even in intermediary care units. 10,11 A significant part of maternal deaths occur after the patient has been admitted in the ICU, and this percentage appears to be on the rise. 11 Some of these deaths inevitably occur even at institutions that provide the best care available.…”

Obstetric admissions to intensive care units in Australia and New Zealand: a registry‐based cohort study

“…Our findings are consistent with earlier international studies where pregnant and postpartum patients account for a relatively low and stable proportion (1-1.5%) of all ICU admissions, 6,11 their median length of stay is brief (1-2 days), and most had an obstetric-related diagnosis. [5][6][7][8][9]11,12,27 However, the crude hospital mortality rate in Australia (0.6%) and New Zealand (1.0%) was lower than that reported from Canada (1.3%), France (1.3%), Maryland (1.8%), the UK (1.9%), Beijing (1.9%) and the Netherlands (3.5%). [5][6][7][8][9][10][11]27 In most of these reports, a greater proportion of patients were intubated and a higher proportion of deaths were due to obstetric-related disease.…”

“…7 The proximate cause of death was unable to be determined, and the ICU admission diagnosis was used to indicate disease categories associated with death. We were 103 (10) 98 (8) 133 (11) 135 (9) 137 (9) 165 (10) 178 (10) 228 (12) 254 (12) 280 (13) 1711 (11) Pre-eclampsia 105 (10) 75 (6) 102 (8) 125 (9) 141 (9) 166 (11) 157 (9) 168 (9) 199 (9) 215 (10) 1453 (9) Non-obstetric diagnoses,n (%) Respiratory 87 (8) 154 (13) 113 (9) 125 (9) 102 7105 7120 7126 7144 7123 (6) 1199 7Cardiovascular 132 (12) 118 (10) 106 (8) 106 (7) 69 (4) 74 (5) 94 5100 5108 (5) 105 (5) 1012 6Sepsis 29 331 352 (4) 60 (4) 71 (5) 74…”

Near Miss Materno: vivência dos enfermeiros obstetras em maternidades de referência

“…No âmbito "satisfação do enfermeiro para prática laboral" acredita-se ser de relevante contribuição para saúde mental e física deste colaborador e, assim, melhora a qualidade de vida no exercício profissional e, por consequência, propicia uma melhor assistência de enfermagem aos clientes. Pesquisas desenvolvidas com trabalhadores de enfermagem de duas UTI do serviço público mostrou que o trabalho quando é desenvolvido em equipe proporciona sentimentos de satisfação(OUD, 2017; SILVEIRA et al, 2012). visto que, quando encontra-se diante de uma nova situação de dificuldade terá subsídios para direcionar a equipe de enfermagem a uma assistência adequada e de qualidade.Agrega-se também para uma prática laboral de qualidade a necessidade de suporte e estrutura física, humana e intelectual, que tornem melhor, as condições de trabalho e assim obtenha uma redução da morbimortalidade materna.…”