Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Greve, Morgan De; Mieghem, Tim Van; Berghe, Greet Van den; Hanssens, Myriam

doi:10.1159/000431224

Cited by 16 publications

(12 citation statements)

References 15 publications

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“…These results are comparable to those obtained in other countries. 5,8,9 The majority of women admitted to ICU were postpartum (90%), which is in accordance with the published literature. 5,[8][9][10][11] The length of ICU stay in present study, 5 days (IQR, 1 -66 days), was comparable with most of the published studies.…”

Section: Discussionsupporting

confidence: 89%

“…5,8,9 The majority of women admitted to ICU were postpartum (90%), which is in accordance with the published literature. 5,[8][9][10][11] The length of ICU stay in present study, 5 days (IQR, 1 -66 days), was comparable with most of the published studies. 5 The most common reasons for ICU admission in this study were hypertensive disorders of pregnancy in 35.5% and obstetric haemorrhage in 24.7%, sepsis/infection in 20.4%, non-obstetric diagnoses in 13% and other obstetric complications in 6.4%.…”

Section: Discussionsupporting

confidence: 89%

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Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre

Oliveira¹,

Filipe²,

Husson³

et al. 2019

Acta Med Port

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Introduction: Maternal mortality and morbidity are important indicators of the quality of health-care services. Obstetric admissions to an intensive care unit may be considered a marker of maternal morbidity. The aim of this study was to determine the incidence, maternal morbidity and mortality of pregnant and postpartum women who required admission to the intensive care unit.Material and Methods: Retrospective analysis of all the obstetric patients admitted to the intensive care unit between 2000 and 2017. Results: Ninety-three women required admission to intensive care (0.7 per 1000 deliveries, 0.8% of all adult admissions). Mean age was 30.3 years, mean gestational age was 33.6 weeks, 51 (54.8%) were primiparous, nine (9.7%) were pregnant of twins and five (5.4%) had not been followed during pregnancy. Eighty-four (90.3%) were admitted after immediate delivery. The most common reasons for admission were hypertensive disorders of pregnancy (35.5%) and obstetric haemorrhage (24.7%). Median length of stay was five days. Transfusion of blood products was needed in 23 (57.0%), artificial ventilation in 50 (53.8%) and use of vasopressors in 21 (22.6%). We observed four maternal deaths (4.3%). Most patients (95.7%) successfully recovered and were transferred to other departments. Sequential Organ Failure Assessment score was significantly associated with maternal mortality.Discussion: Our results are comparable to those obtained in other studies. Maternal mortality was comparable to maternal mortality in developed countries.Conclusion: The incidence of obstetric admissions to the intensive care unit was 0.8% and 0.7 per 1000 deliveries. Hypertensive disorders of pregnancy were the main causes of admission. Maternal mortality was 4.3%. Studies of maternal morbidity are important and can help to improve the quality of health care services.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre

Oliveira¹,

Filipe²,

Husson³

et al. 2019

Acta Med Port

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“…In our study, cardiac disorder was the most common reason for non-obstetric causes of ICU admission, in contrast with the findings of other studies in which sepsis was reported to be the predominant non-obstetric reason for ICU admission [8,10,11]. In Belgium, however, pre-existing and acquired cardiopathies were the most common cause for ICU admission and surpassed hypertensive disorders and hemorrhage [12]. In our hospital, the cardiac critical care unit (CCU) is a relatively independent intensive care unit, and this study did not include critically ill obstetric women in the CCU.…”

Section: Discussioncontrasting

confidence: 98%

Clinical characteristics and outcomes of obstetric patients requiring ICU admission: a 5-year retrospective review

Zhang,

Tang,

Wen

et al. 2021

Clin. Exp. Obstet. Gynecol.

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To investigate the clinical characteristics and outcomes of obstetric patients requiring intensive care unit (ICU) admission in a tertiary hospital. Methods: We retrospectively analyzed the clinical data of all pregnant/postpartum patients admitted to a tertiary ICU from January 2014 to December 2018. Result: One hundred and thirty-three obstetric patients were analyzed. Most patients (114, 85.7%) were admitted postpartum, and 57.9% (n = 77) of ICU admissions were from obstetric causes. The most common obstetric cause of admission was obstetric hemorrhage (32, 24.1%), followed by pregnancy-associated hypertension (25, 18.8%). The most common non-obstetric cause of admission was cardiac disorder (16, 12%). Ninety-eight patients (73.7%) came from non-urban areas. We compared patients from non-urban areas versus urban areas: Acute Physiology and Chronic Health Evaluation (APACHE) II, 8.35 ± 3.14 versus 6.43 ± 2.59 (P = 0.002); standard prenatal care, 62.3% versus 90.3% (P = 0.004); transferred from another hospital, 25.5% versus 2.9% (P = 0.004); blood transfusion, 48% versus 22.9% (P = 0.010); plasmapheresis, 11.2% versus 0% (P = 0.039); multiple-organ dysfunction syndrome, 30.6% versus 11.4% (P = 0.026); mortality, 10.2% versus 2.9% (P = 0.176). Total maternal mortality in ICU was 8.3% (n = 11). The fetal mortality rate was 10.9% (n = 15). Conclusions: A multidisciplinary team approach is essential to improve the management of obstetric hemorrhage, hypertensive disorders and cardiac disorders, which may in turn significantly improve maternal outcomes. Health disparities existed between patients from non-urban versus urban areas: the former was sicker at admission, received less standard prenatal care, were more frequently transferred from other hospitals, received more interventions, developed more complication, and suffered a higher rate of maternal mortality.

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“…(25) This difference might be due to socioeconomic conditions, the quality of prenatal care, or better modalities of treatment in the ICU. (26) …”

Section: Discussionmentioning

confidence: 99%

Factors associated with maternal death in an intensive care unit

Saintrain¹,

Oliveira²,

Saintrain³

et al. 2016

Revista Brasileira De Terapia Intensiva

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ObjectiveTo identify factors associated with maternal death in patients admitted to an intensive care unit.MethodsA cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis.ResultsA total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65).ConclusionThe frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death.

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Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Cited by 16 publications

References 15 publications

Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre

Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre

Clinical characteristics and outcomes of obstetric patients requiring ICU admission: a 5-year retrospective review

Factors associated with maternal death in an intensive care unit

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