Gestational and Puerperal Complications in Icu: An Integrative Literature Review

Abstract

Given the complexity of clinical pregnancy situations that require more intensive care, there are several indications for the hospitalization of pregnant women in the Intensive Care Unit. Thus, the role of intensive obstetric care is of fundamental importance in reducing maternal morbidity and mortality. For this, it is important to have a detailed knowledge of the main serious conditions that affect women during this period of life, in order to provide a better approach by intensive care professionals. Thus, this study aimed to review the gestational and puerperal complications in the ICU, describing the main serious conditions that affect these patients. This is an integrative literature review study in which the LILACS and SciELO online databases were used, using the descriptors present in the Descriptors in Health Science/ Medical Subject Headings (DeSC/MeSH): Complications in Pregnancy ( "Pregnancy Complications"); Intensive Care Units ("Intensive Care Units"); Maternal Mortality. The controlled descriptor "Intensive Care Units" associated with the Boolean operator AND to the aforementioned descriptors was used. Data collection, reading and analysis took place between November/2021 and April/2022 and was performed by the study authors. The electronic search in databases resulted in the identification of 734 studies, of which 23 had titles or abstracts that mentioned the presentation of original data on gestational and puerperal complications in intensive care, or were deemed relevant to the topic under study. Of these, 10 studies did not allow the determination of the profile of pregnant and postpartum women and the main serious conditions that affect these patients, being therefore considered ineligible for inclusion in this integrative review, totaling, in the end, 13 studies to be analyzed. 12 articles were cross-sectional and descriptive studies and only one cohort. All researches were documentary, carried out in medical records, except for one in which secondary data from the waiting list for ICU beds, provided by the Bed Regulation Center, were used. The sample size ranged from 26 to 500 women, with an average of 19 to 35 years, all hospitalized in Brazilian ICUs. The main causes of ICU admission were: pregnancy-specific hypertensive disease, infectious and hemorrhagic conditions of any etiology. Other causes described were: premature labor; intrapartum shock; premature rupture of amniotic membrane; edema; Hellp syndrome. Among the nonobstetric causes, the following were cited: heart disease, deep vein thrombosis, urinary tract infection, asthma, acute pulmonary edema and community pneumonia. The study provided an overview of the situation of hospitalization of obstetric patients in an ICU.