Obstetric admissions to intensive care units in Australia and New Zealand: a registry‐based cohort study

Maiden, Matthew J; Finnis, Mark; Duke, Graeme; Huning, Emily Ys; Crozier, Tim M.; Nguyen, Nhi; Biradar, Vishwanath; McArthur, Colin; Pilcher, David

doi:10.1111/1471-0528.16285

Cited by 15 publications

(28 citation statements)

References 23 publications

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“…The occurrence of obstetric admission to ICU in the present study was much higher (4.1%) considering the total number of deliveries in the two maternity hospitals than that reported in developed countries or even in developing countries. A study conducted in Australia and New Zealand found an annual average of 1.3% of ICU admissions (Alkema et al , 2016; Maiden et al , 2020), and the frequency in India was 0.5% (Vargas et al , 2019). The results were also higher than the WHO estimate for pregnant Brazilians requiring ICU admission (2.1%) (Souza et al , 2010).…”

Section: Discussionmentioning

confidence: 99%

Adverse obstetric outcomes in two Brazilian maternity hospitals

Andrade

Gama

Freitas

et al. 2021

IJHCQA

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PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

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Section: Discussionmentioning

confidence: 99%

Adverse obstetric outcomes in two Brazilian maternity hospitals

Andrade

Gama

Freitas

et al. 2021

IJHCQA

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“…Although obstetric causes are the main reason for MNM admitted to the ICU [42,43], considering the development of reproductive medicine and other related medicine, perinatal complications and comorbidities tend to occur in women with underlying diseases, which make the treatments of indirect obstetric causes too complex and beyond the capacity of obstetricians [44]. The main indirect obstetric cause of MNM admitted to the ICU was heart-related diseases, while the control group is epilepsy .According to a national research studied in China, the incidence of MMR caused by heart-related diseases rose by 1.5 per 100,000 between 2013 and 2016 [11].…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

Chen¹,

Shi²,

Zhu³

et al. 2020

Preprint

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BackgroundThe maternal near-miss (MNM) criterion formulated by the WHO can dynamically evaluate the obstetric quality and maternal health in medical institutions. The study aims to explore the incidence, risk factors, and causes of MNM cases admitted to the intensive care unit (ICU) within 5 years.MethodsThis study is a retrospective study. The data of MNM admitted to the ICU comes from the medical records of Subei People's Hospital in Yangzhou from 2015 to 2019. The study subjects meet at least one World Health Organization (WHO) criterion of MNM. The MNM who had not been admitted to the ICU in the same year served as the control group. We use descriptive analysis, Chi-Square test and Fisher’s exact test for data analysis.Results151 women met the WHO criteria of MNM and there was one maternal death in 2016. The average maternal near-miss rate（MNMR）for ICU admission was 3.5 per 1,000LBs, and the average MNM morbidity was 0.36%. The average maternal mortality ratio (MMR) was 5 per 100,000LBs. The 5-year research period witnessed moderate growth in MNM admitted to the ICU. The region, referral, gravidity, prenatal examination, and mode of delivery were significantly related to the MNM admitted to the ICU(p<0.05). Concerning neonatal characteristics, there is a significant difference in preterm birth rate and low Apgar scores at 1 min and 5 min(p<0.05). The direct obstetric causes were the primary cause of MNM, regardless of the ICU admission. The leading direct obstetric causes of MNM admitted to the ICU were obstetric hemorrhage diseases(38.8%)，following hypertension diseases(18.8%), while the leading indirect obstetric cause of MNM admitted to the ICU was heart-related diseases (7.2%). MNM for the ICU admission were mostly postpartum (96.9%), who underwent multiple interventions.ConclusionsICU is one of the most important endpoints of MNM management. In the context of "universal two-child", medical institutions should strengthen multidisciplinary joint treatment. In the future, it needs to be expanded to multi-center research to determine the criteria for MNM admitted to the ICU.

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“…The incidence of severe disease, and the rates of mechanical ventilation and mortality are also observed to be higher in Sub-Saharan Africa than in developed countries [1]. As many as 90% of ICU patients in developing countries required mechanical ventilation [10], whereas much lower rates of 19%-45% have been reported in high-income countries such as Netherlands and Australia [11][12][13]. Mortality rates following obstetric ICU admission of 34.8%-49% have been reported in sub-Saharan Africa [2,6,10] compared to 5.1% in China and <1% in Australia and New Zealand [11,14].…”

Section: Plos Onementioning

confidence: 99%

“…As many as 90% of ICU patients in developing countries required mechanical ventilation [10], whereas much lower rates of 19%-45% have been reported in high-income countries such as Netherlands and Australia [11][12][13]. Mortality rates following obstetric ICU admission of 34.8%-49% have been reported in sub-Saharan Africa [2,6,10] compared to 5.1% in China and <1% in Australia and New Zealand [11,14]. A mean duration of stay of 3-4 days has been reported in Asia and Europe [12,15] and hypertensive disorders of pregnancy (HDP), hemorrhage, and sepsis are often the main indications for ICU admission [1,2,6].…”

Section: Plos Onementioning

confidence: 99%

“…Although obstetric cases accounted for a relatively high proportion of all ICU admissions compared to other countries [18][19][20][21][22], the associated mortality rate of 26% is markedly lower than the 35%-54% reported in other African countries [2,6,10,35]. However, it remains higher than rates reported in high-income countries including Australia and the Netherlands [11,14,36]. It is unclear why the proportion of obstetric ICU admissions that died in the present study is lower than that in other African countries where the health care system is unlikely to be different from that of Ghana.…”

Section: Plos Onementioning

confidence: 99%

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A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country

et al. 2021

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Introduction Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. Methods This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. Results There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. Conclusion Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. Plain language summary This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.

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Obstetric admissions to intensive care units in Australia and New Zealand: a registry‐based cohort study

Cited by 15 publications

References 23 publications

Adverse obstetric outcomes in two Brazilian maternity hospitals

Adverse obstetric outcomes in two Brazilian maternity hospitals

Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country

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