Indications and outcome for intensive care unit admission during puerperium

A significant decrease of maternal mortality related to improvement in diagnosis and prevention of disorders in pregnancy has been observed without a similar reduction of puerperal morbidity. Objective of this study was to identify risk factors and outcome of patients, which required intensive care during puerperium.

During the period 1987-1998 all pregnant patients, which were transferred from Department of Obstetrics and Gynecology to Intensive Care Unit (ICU) of University of Bari, were retrospectively included into the study. Several risk factors (age, preexisting diseases, gestational age, medical complication of pregnancy, mode of delivery, surgical additional procedure, fetal outcome, intrapartum transfusions, and puerperal complications) and the indications for transfer were evaluated.

The overall incidence of admission into Intensive Care Unit was 0.17% (41/23.694) of deliveries. Indications for admission into ICU were worsening of preeclampsia in 75.6% of cases, severe bleeding in 14.7% of cases, maternal cardiac disease stage III AHA in 4.9% of cases, pulmonary embolism and acute pulmonary oedema respectively in 2.4% of cases.

Transfer of patients to ICU due to hypovolemic postraumatic shock seems progressively declining thanks to modern criteria of obstetric management; on the contrary we assist to a prevalence of serious intrinsic maternal diseases often preexisting pregnancy or late consequence of preeclampsia, pulmonary embolism and sequelae of abnormal insertion of placenta.