Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy

Zieleskiewicz, Laurent; Chantry, Anne; Duclos, Gary; Bourgoin, A; Mignon, Alexandre; Deneux‐Tharaux, Catherine; Léone, Marc

doi:10.1016/j.accpm.2016.06.005

Cited by 43 publications

(45 citation statements)

References 91 publications

(82 reference statements)

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“…Thus, studies of the epidemiology of ICU admissions of obstetric patients are considered to represent a useful proxy of severe maternal morbidity and near-miss events that can inform interventions to improve maternal outcomes [6-8]. However, there has been no agreed upon definition of severe maternal morbidity [6] and the recent consensus-based criteria for near-miss events put forward by the World Health Organization (WHO) [9] remain controversial [10, 11]. In addition, while contemporary guidelines stress the overarching goal that ICU admissions should be reserved for those patients who are likely to benefit [12], there have been no evidence-based data to guide clinicians in triaging obstetric patients to ICU [13, 14].…”

Section: Introductionmentioning

confidence: 99%

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

Oud

2017

J Clin Med Res

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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.

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Section: Introductionmentioning

confidence: 99%

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

Oud

2017

J Clin Med Res

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“…The annual MMR in the United Sates during 2013 was 28 maternal deaths per 100,000 births, which has doubled from the 12 per 100,000 that was recorded in 1990 (7). This can be potentially attributed to the significant increase in the rates of cesarean sections and the increase in age at conception, which in combination with the broader applications of assisted reproduction technologies, result in higher-risk pregnancies in patients of advanced reproductive age who are more likely to present with comorbidities (8). In 2008, the MMR in developing countries was 15x higher compared with the developed world (9).…”

Section: Epidemiologymentioning

confidence: 99%

Role of Critical Care Units in the management of obstetric patients (Review)

et al. 2021

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Pregnancy is considered a natural process for the majority of women. However, a limited proportion of pregnancies and deliveries can present with a broad variety of complications that may require admission to a Critical Care Unit (CCU). In the present review, the indications of admission of obstetrical and postpartum patients to CCUs were critically evaluated with a particular focus on the management of their complications. The management of critically ill obstetric patients remains challenging due to the physiological changes that occur during pregnancy, pregnancy-related diseases and the need to carefully consider the well-being of the fetus before any intervention can be recommended/performed. Indications for admission to CCUs include both obstetric and non-obstetric conditions that may require continuous monitoring and further interventions. Hypertensive disorders of pregnancy and mass hemorrhage are amongst the most common causes of admission to CCUs in pregnant and postpartum women. The establishment of a diagnostic and care algorithm based on the contribution of a multidisciplinary team is of critical importance to aid in the determination of which patients will require intensive care, and to assist in deciding what type of critical care each critically ill patients receives.

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“…It also has the potential for maternal bed‐side diagnostic and screening procedures, and can be seen as an extension of clinical assessment . Pregnancy is associated with increased risk of aspiration of gastric contents, difficult airway access, acute respiratory failure and cardiovascular compromise . This review covers the use of ultrasound for assessment of gastric contents and the airway, management of the breathless patient, prediction of fluid responsiveness and diagnosis of shock.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management

et al. 2018

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Complications during pregnancy are not frequent, but may occur abruptly. Point-of-care ultrasound is a non-invasive, non-ionising diagnostic tool that is available at the bed-side when complications occur. This review covers the use of ultrasound in various clinical situations. Gastric ultrasound can identify stomach contents that put the woman at risk for pulmonary aspiration. In the future, this tool will probably be used routinely before induction of anaesthesia to determine the presence of stomach contents above a particular risk threshold. Difficult tracheal intubation, and the potential for 'can't intubate, can't oxygenate', is more frequent in pregnant women. Point-of-care ultrasound of the airway allows accurate identification of the cricothyroid membrane, permitting rapid and safer establishment of front-of-neck airway access. Combined cardiac and lung ultrasound can determine the potential risk:benefit of fluid administration in the pregnant patient. Such prediction is of critical importance, given the tendency of pregnant women to develop pulmonary oedema. Combined echocardiography and lung ultrasound can be combined with ultrasound of the leg veins to differentiate between the various causes of acute respiratory failure, and guide treatment in this situation. Finally, as shown in the general population, multi-organ point-of-care ultrasound allows early diagnosis of the main causes of circulatory failure and cardiac arrest at the bed-side. As the importance of point-of-care ultrasound in critical patients is increasingly recognised, it is emerging as an important tool in the therapeutic armoury of obstetric anaesthetists.

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Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy

Cited by 43 publications

References 91 publications

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

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

Role of Critical Care Units in the management of obstetric patients (Review)

Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management

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