Obstetric patients in a surgical intensive care unit: prognostic factors and outcome

Abstract

The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

Admissions of women in the third trimester of pregnancy to an intensive care unit in Morocco over a 4‐year period

“…Hypertensive disorders and obstetric hemorrhage are the predominant causes of such admissions [1][2][3][4][5]. Maternal mortality in ICUs varied from 0.15%-9.4% in highresource countries and from 6.9%-16.7% in low-resource countries [1][2][3][4][5]. In the present study, the maternal mortality rate was 9.7%.…”

“…Admissions in the third trimester of pregnancy represent more than two-thirds of the total obstetric admissions to the ICU [1][2][3][4][5]. Hypertensive disorders and obstetric hemorrhage are the predominant causes of such admissions [1][2][3][4][5]. Maternal mortality in ICUs varied from 0.15%-9.4% in highresource countries and from 6.9%-16.7% in low-resource countries [1][2][3][4][5].…”

“…A total of 88 (61.1%) patients had a favorable outcome and were transferred to the maternity department within 72 hours. A total of 42 (29.1%) patients developed obstetric complications other than the pathologies that necessitated their initial admission.The reported incidence of obstetric admissions to ICUs varied from 0.22%-1.54% in high-resource countries and 0.37%-0.6% in low-resource countries [1][2][3][4][5]. Admissions in the third trimester of pregnancy represent more than two-thirds of the total obstetric admissions to the ICU [1-5].…”

“…Admissions in the third trimester of pregnancy represent more than two-thirds of the total obstetric admissions to the ICU [1-5]. Hypertensive disorders and obstetric hemorrhage are the predominant causes of such admissions [1][2][3][4][5].…”

Study of Severe Acute Maternal Morbidity (SAMM) in A Tertiary Care Hospital

“…6,7 In countries with low resources, prevalence ranges from 0.6 to 8.5%. 8 In spite of the high maternal mortality ratios in many of the centers in resourcepoor settings, the actual number of maternal deaths per centre may not allow detailed quantification of associated risk factors and determinants that are locally important. 9 SAMM events occur in larger numbers and are thought to provide more information about standards of care and specific local considerations than can be provided by maternal deaths.…”