Intensive care unit admission of obstetric cases: a single centre experience with contemporary update

Abstract

OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.

Outcomes of Antepartum and Postpartum Obstetric Admissions to the Intensive Care Unit of A Tertiary University Hospital: An 8-Year Review

“…A study in a regional hospital in Hong Kong on 50 obstetric patients reported postpartum haemorrhage, pregnancy-associated hypertension and sepsis as the main causes of obstetric admission to Turk J Anaesthesiol Reanim 2017; 45: 303-9 (24). The same group recently updated their evaluation in a retrospective review of 67 patients and indicated that postpartum haemorrhage and pre-eclampsia/eclampsia are still the most common obstetric causes (21). Retrospective analyses of obstetric patients over a 7 year period indicated that pre-eclampsia/eclampsia and obstetric haemorrhage are the main causes for admission to the ICU in Jordan (25).…”

Intimate partner violence and severe acute maternal morbidity in the intensive care unit: A case‐control study in Peru

“…Whereas the overall perinatal mortality rate in the ICU was lower than in other high‐income countries, the NICU admission rate was comparable, suggesting that mothers with severe acute maternal morbidity had a significantly greater proportion of premature newborns, which can affect perinatal outcomes including neonatal mortality and NICU admission. Because of the lack of power, we were unable to examine the influence of intimate partner violence on perinatal outcomes independent of the severe acute maternal morbidity.…”

Pattern of admissions, clinical course and short term outcome of patients admitted to an obstetric ICU of a tertiary care hospital of north India: a retrospective study

“…The most common indication for ICU admission has been either eclampsia/preclampsia or obstetric haemorrhage. [1][2][3][4][5][6][7] In brief pregnancy related hypertensive disorders and Obstetric haemorrhage together account for majority of the patients admitted to ICU. In addition to direct obstetric causes we had around eight patients who were admitted because of indirect obstetric causes.…”

“…In India the maternal mortality has been reported between 12-33%, while perinatal mortality has been reported as 12-47%. 2,[6][7][8][9][10][11][12][13] Four mothers died ,2 because of PPH, 1 of abruptio placentae and 1 of Uterine rupture. Most of maternal deaths that have occurred in other studies have been because of obstetric haemorrhage.…”

“…In some reports from developed countries the common causes of admission include pregnancy related hypertensive disorders, obstetric haemorrhages. [1][2][3][4][5][6][7] In India studies have shown pregnancy related hypertensive disorders, obstetric haemorrhages and sepsis to be common indications for ICU admission. [8][9][10][11][12][13] The fetal and maternal outcome in the ICUs also varies between regions.…”