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

Abstract

Recourse to the intensive care unit (ICU) for obstetric complications is relatively rare. However, in low-resource countries the technical and organizational capacities required for hospital management of serious complications of pregnancy are often limited. The aim of the present study was to determine the occurrence of third trimester obstetric admissions to an ICU in Morocco over a 4-year period, and to identify the associated obstetric pathologies.A retrospective study covering the 4-year period from June 1, 2007, to June 1, 2011, was conducted at the multipurpose ICU of Al Farabi regional hospital in Oujda, Morocco. Inclusion criteria were women who had been admitted to the ICU in the third trimester of pregnancy (over 28 weeks) or the early postpartum period (b7 days after delivery), who were free of pre-existing comorbidities (arterial hypertension, diabetes, and cardiopathy).There were 29 300 deliveries during the study period. A total of 217 (0.74%) obstetric patients were admitted to the ICU (7.4 per 1000 deliveries), including 157 (0.53%) patients admitted in the third trimester or early postpartum period (5.3 per 1000 deliveries). The main indications for admission to the ICU were severe preeclampsia/eclampsia, obstetric hemorrhage, and sepsis. Of the 157 admissions, 144 met the criteria and were included in the study. This constituted 6.1% of the 2346 total ICU admissions. There were 14 (9.7%) maternal deaths among the 144 women admitted to the ICU in the third trimester of pregnancy or the early postpartum period.The mean age of the 144 patients was 29 ± 7 years. Absence of prenatal medical care was observed in 83 (57.6%) patients and 77 (53.5%) were primiparous. Singleton pregnancy occurred in 139 (96.5%) patients and emergency cesarean delivery was performed in 111 (77.1%). The obstetric complications associated with admission to the ICU are given in Table 1. 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]. Hypertensive disorders and obstetric hemorrhage are the predominant causes of such admissions [1][2][3][4][5].

An Integrated Review of Obstetric Admissions in the Intensive Care Unit

“…Their admission to ICUs remains relatively rare. 10,11,[13][14][15]17,19,21,22,28 Lack of exposure can exacerbate feelings and unfamiliarity and erode confidence in nurses. This can directly translate to patient care, as it did in one study that directly examined ICU nurses' attitudes toward caring for obstetric patients in the ICU: "Although many of the therapeutic interventions required by these women is similar to the care required by all patients admitted to critical care areas, some nurses were unable to translate these skills to obstetric patients because of low levels of confidence when faced with this unfamiliar group of patients."…”

“…These differences create challenges for an ICU nurse when he/she is tasked with caring for an obstetric patient within the ICU. Their admission to ICUs remains relatively rare 10,11,13–15,17,19,21,22,28 . Lack of exposure can exacerbate feelings and unfamiliarity and erode confidence in nurses.…”

“…Overall, the incidence of these cases remained extremely low; less than 1% in most cases. 1,10,11,[13][14][15]17,19,23,24 Notable exceptions include Paxton and colleagues' 8 study of admissions to a quaternary, maternity hospital in Brisbane, Australia, Maiden and colleagues' 16 study of admissions to ICUs in Australia and New Zealand, and Oud's 18 study of all pregnancy-related admissions in Texas. Quaternary hospitals are considered extensions of tertiary care, although even more highly specialized, focusing on specific diagnoses, treatments, or patient populations.…”

“…A US study from the state of Maryland and a Saudi Arabian study both found admission rates less than 1%, consistent with the low rates of obstetric patients who required intensive care. 10,20 Bentata and colleagues' 13 Moroccan study found that obstetric cases accounted for 9.27% of all intensive care admissions. Paxton and colleagues' 8 study identified a rate of 19%, which may, again, be explained by the nature of the setting of the quaternary, maternity hospital (Figure 3).…”

“…The mean age of women with obstetric intensive care admissions ranged from 29 to 32 years. 8,[12][13][14][15][16][17]19 Admissions were categorized as either obstetric or nonobstetric in nature, and multiple studies organized participants according to whether they were in the antepartum, peripartum, or postpartum period of their pregnancy.…”