Epidemiology of Obstetric-Related ICU Admissions in Maryland

Abstract

Objective To define the incidence, indications, and temporal trends in obstetric-related intensive care unit (ICU) admissions Design Descriptive analysis of utilization patterns Setting All hospitals within the State of Maryland Patients All antepartum, delivery and postpartum patients who were hospitalized between 1999 and 2008 Interventions None Measurements and Main Results We identified 2,927 ICU admissions from 765,598 admissions for antepartum, delivery, or postpartum conditions using appropriate International Classification of Diseases, 9th revision-Clinical Modification (ICD-9 CM) codes. The overall rate of ICU utilization was 419.1 per 100,000 deliveries, with rates of 162.5, 202.6 and 54.0 per 100,000 deliveries for the antepartum, delivery and postpartum periods, respectively. The leading diagnoses associated with ICU admission were pregnancy-related hypertensive disease (present in 29.9% of admissions), hemorrhage (18.8%), cardiomyopathy or other cardiac disease (18.3%), genitourinary infection (11.5%), complications from ectopic pregnancies and abortions (10.3%), non-genitourinary infection (10.1%), sepsis (7.1%), cerebrovascular disease (5.8%) and pulmonary embolism (3.7%). We assessed for changes in the most common diagnoses in the ICU population over time and found rising rates of sepsis (10.1 per 100,000 deliveries to 16.6 per 100,000 deliveries, p=0.003) and trauma (9.2 per 100,000 deliveries to 13.6 per 100,000 deliveries, p=0.026) with decreasing rates of anesthetic complications (11.3 per 100,000 to 4.7 per 100,000, p=0.006). The overall frequency of obstetric-related ICU admission and the rates for other indications remained relatively stable. Conclusions Between 1999 and 2008, 419.1 per 100,000 deliveries in Maryland were complicated by ICU admission. Hospitals providing obstetric services should plan for appropriate critical care management and/or transfer of women with severe morbidities during pregnancy.

Study of Obstetric Admissions to the Intensive Care Unit of a Tertiary Care Hospital

“…Studies done so far report postpartum admissions as the majority. Some studies have reported a majority of antepartum admissions [13,20], and delivery admissions (on the day of delivery) [6,21], some studies have reported a high rate, though not the majority [10,15]. Epidemiology of antepartum admissions needs further research.…”

“…For hypertensive disorders, the range is 7-73.6 % from 24 studies , and the mean is 34.85 %. For obstetric hemorrhage, the range is 11-62.5 %, and the mean is 27.90 % from 23 studies [1][2][3][4][5][6][7][8][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24].…”

“…The percentage of obstetric population requiring admission to the ICU is different in different countries based on the socioeconomic status, criteria for ICU admission, availability of ICU beds, and availability of a high dependency unit. It ranges from 0.08 to 0.76 % of deliveries in developed countries [3][4][5][6][7] and 0.13 to 4.6 % in developing countries [1,[8][9][10][11][12][13][14][15]. The mortality in these patients is high and ranges from 0 to 4.9 % of ICU admissions in developed [4][5][6][7] and 2-43.63 % in developing countries [8-11, 13, 15, 16].…”

Admission of women to an intensive care unit during pregnancy or the postpartum period

“…La proporción de ingreso a UCI encontrada durante el tiempo estudiado (0,43%) se encuentra dentro de las frecuencias referidas en la literatura (6) .…”

“…De esos ingresos, 2.927 utilizaron la UCI (0,38%); 1415 de los ingresos en la UCI se produjo durante la hospitalización para el nacimiento, mayor proporción en mujeres fueron mujeres que se encontraban los extremos de la edad reproductiva, raza negra, la tasa global de utilización de la UCI fue 419/100.000 partos, durante el periodo anteparto 162/100.000, parto 202/100.000 y 54/100.000 durante el puerperio (6) .…”