Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception

Abstract

BACKGROUND: The use of in vitro fertilization is increasing. The incidence of adverse outcomes is greater for women who undergo in vitro fertilization, potentially leading to intensive care unit admission. This study aimed to assess the etiology and course of intensive care unit admission in women who underwent in vitro fertilization compared to those who did not, with specific focus on intensive care unit admission due to postpartum hemorrhage. METHODS: In this retrospective study, medical records of patients admitted to the intensive care unit during pregnancy or the peripartum period at 2 medical centers (2005–2016 at Mount Sinai Hospital, New York, NY, and 2005–2013 at Shaare Zedek Medical Center, Jerusalem, Israel) were analyzed. Demographic, past medical and obstetric history, and details regarding delivery and intensive care unit stay were collected, as was information regarding mode of conception (in vitro fertilization versus non–in vitro fertilization) for the current pregnancy. The primary outcome measure was difference in etiology of intensive care unit admission between in vitro fertilization and non–in vitro fertilization groups. Secondary outcome measures included differences in prepregnancy characteristics, incidence, severity, and management of postpartum hemorrhage, as well as incidence of other clinical major morbidity events and delivery-related complications. Multivariable logistic regression was performed to study the relationship between in vitro fertilization and the odds of having been admitted to the intensive care unit due to hemorrhage. RESULTS: During the study period, there were nearly 192,000 deliveries, with 428 pregnant and peripartum women admitted to the intensive care unit. Of the 409 cases analyzed, 60 had conceived following in vitro fertilization and 349 had conceived without in vitro fertilization. The non–in vitro fertilization group was more likely to have multiple medical comorbidities, and the in vitro fertilization group was more likely to have multiple gestations. The groups also differed in etiology of intensive care unit admission; more women in the in vitro fertilization group were admitted due to a pregnancy-related complication. Intensive care unit admission for postpartum hemorrhage was more frequent in the in vitro fertilization group (60.0% vs 43.1%, P = .014), with a 2-fold increase in the incidence of hemorrhagic shock. Logistic regression analysis revealed a 2-fold increase in the odds that intensive care unit admission was due to hemorrhage in women undergoing in vitro fertilization, a finding that was not statistically significant when multiple gestation was added to the model. CONCLUSIONS: Among patients admitted to the intensive care unit, patients with different modes of conception had dissimilar etiologies for intensive care unit admission with intensive care unit admission due to hemorrhage greater in those with in vitro fertilization. Higher rates of multiple gestation pregnancies may explain this difference. Differences in pregnancies conceived via in vitro fertilization versus without in vitro fertilization may affect the obstetric intensive care unit case mix.

Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

“…Due to the implementation of the two-child policy in China, since 2016, the number of pregnant women with an older maternal age and history of caesarean section has increased, which has further increased the incidence of gestational diabetes mellitus, dangerous placenta previa, placental implantation, and severe postpartum haemorrhage [3][4][5]. Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of SAMM [2,[6][7][8][9][10][11]. ICU admission of pregnant and postpartum women presents signi cant challenges to ICU clinicians because of altered maternal physiology, foetal considerations and medical emergencies associated with pregnancy [12,13].…”

Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

“…Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of SAMM [2,[6][7][8][9][10][11]. ICU admission of pregnant and postpartum women presents signi cant challenges to ICU clinicians because of altered maternal physiology, fetal considerations and medical emergencies associated with pregnancy [12,13].…”