Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre

Abstract

Introduction: Maternal mortality and morbidity are important indicators of the quality of health-care services. Obstetric admissions to an intensive care unit may be considered a marker of maternal morbidity. The aim of this study was to determine the incidence, maternal morbidity and mortality of pregnant and postpartum women who required admission to the intensive care unit.Material and Methods: Retrospective analysis of all the obstetric patients admitted to the intensive care unit between 2000 and 2017. Results: Ninety-three women required admission to intensive care (0.7 per 1000 deliveries, 0.8% of all adult admissions). Mean age was 30.3 years, mean gestational age was 33.6 weeks, 51 (54.8%) were primiparous, nine (9.7%) were pregnant of twins and five (5.4%) had not been followed during pregnancy. Eighty-four (90.3%) were admitted after immediate delivery. The most common reasons for admission were hypertensive disorders of pregnancy (35.5%) and obstetric haemorrhage (24.7%). Median length of stay was five days. Transfusion of blood products was needed in 23 (57.0%), artificial ventilation in 50 (53.8%) and use of vasopressors in 21 (22.6%). We observed four maternal deaths (4.3%). Most patients (95.7%) successfully recovered and were transferred to other departments. Sequential Organ Failure Assessment score was significantly associated with maternal mortality.Discussion: Our results are comparable to those obtained in other studies. Maternal mortality was comparable to maternal mortality in developed countries.Conclusion: The incidence of obstetric admissions to the intensive care unit was 0.8% and 0.7 per 1000 deliveries. Hypertensive disorders of pregnancy were the main causes of admission. Maternal mortality was 4.3%. Studies of maternal morbidity are important and can help to improve the quality of health care services.

Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study

“…In this study, average MNMIR for ICU admission was 3.5 per 1000 live births, using WHO-MNM criteria. Our MNMIR was higher than that in high income countries, such as New Zealand (2.1) and Portugal (0.7) [16,17]. An explanation could be that our study was in a referral tertiary hospital with a high migrant population.…”

Perfil De Pacientes Obstétricas Admitidas Na Unidade De Terapia Intensiva De Um Hospital Público

“…Com relação à paridade, aproximadamente metade das mulheres teve apenas uma gestação e também eram primíparas, dado que corrobora estudo retrospectivo, realizado em um Hospital Terciário, em Portugal, com uma amostra de 93 pacientes, das quais 56,8% eram primíparas (16) .…”

“…As síndromes hipertensivas associadas à gestação (pré-eclâmpsia, Síndrome HELLP e eclâmpsia) foram a principal causa de internamento na UTI, o que corrobora outros estudos nacionais (8)(9) e internacionais (15)(16) . Esse dado é importante e confirma o que traz a literatura: a hipertensão é a causa principal de morte materna no Brasil, é uma complicação passível de tratamento e a qualidade da assistência pode ser decisiva no desfecho desses casos.…”