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Obstetric patients requiring critical care. A five-year review
1Department of OB-GYN, University of California, San Francisco 94143.
Insights
Critically ill obstetric patients admitted to the intensive care unit (ICU) often require admission for postpartum complications, with preeclampsia being a common diagnosis. Fetal survival is high, but maternal outcomes require careful management.
Area of Science:
- Obstetrics
- Critical Care Medicine
- Maternal-Fetal Medicine
Background:
- Limited research exists on the clinical issues and outcomes of critically ill obstetric patients requiring intensive care unit (ICU) admission.
- Understanding the indications for ICU admission and associated maternal and fetal morbidity is crucial for improving care.
Purpose of the Study:
- To review obstetric patients admitted to a medical-surgical ICU over a five-year period.
- To analyze the medical indications for ICU admission, diagnoses, and outcomes (morbidity and mortality) for both mother and fetus.
Main Methods:
- Retrospective review of 32 obstetric patients admitted to a tertiary care ICU over five years.
- Data collected included obstetric, ICU-specific, and diagnostic information.
- Classified primary diagnoses as obstetric or non-obstetric and reasons for ICU admission (respiratory failure, hemodynamic instability, neurologic dysfunction).
Main Results:
- Obstetric admissions constituted 0.4% of deliveries; most admissions were postpartum.
- Preeclampsia was the most frequent diagnosis (22%).
- Hemodynamic instability was a major cause of postpartum ICU admission (52%), but not antepartum.
- Seven of eight antepartum patients delivered in the ICU; all fetuses survived.
- Acute lung injury occurred in 25% of cases, often linked to infection, with a 25% overall mortality rate.
Conclusions:
- Postpartum complications, particularly preeclampsia and hemodynamic instability, are significant reasons for ICU admission in obstetric patients.
- While fetal outcomes are generally favorable, critical maternal illness presents challenges, with high rates of acute lung injury and significant mortality.
Abstract:
Only one study has examined the clinical issues presented by critically ill obstetric patients with respect to medical indications for intensive care unit (ICU) admission and fetal and maternal morbidity and mortality. Therefore, a review of all obstetric patients admitted to a medical-surgical ICU in a large tertiary referral center over a five-year period was conducted. Obstetric, ICU-related, and diagnostic data were recorded for each patient. The diagnosis of the disease responsible for the patient's critical illness was categorized as obstetric or nonobstetric. The diagnosis that prompted ICU admission was determined for each patient and was categorized as respiratory failure, hemodynamic instability, or neurologic dysfunction. There were 32 obstetric admissions representing 0.4 percent of all deliveries during this time period. There was a predominance of postpartum admissions and obstetric diagnoses responsible for the patient's critical illness. Preeclampsia was the single most common diagnosis representing 22 percent of all patients. Hemodynamic instability was never the cause of antepartum ICU admission in patients with a viable fetus. In contrast, hemodynamic instability accounted for 52 percent of postpartum ICU admissions. Of the eight women admitted with viable pregnancies to the ICU, seven were delivered during the ICU stay and all fetuses survived. There was a high incidence of acute lung injury (25 percent) that was associated with nonpulmonary or pulmonary infection in all eight cases. However, the mortality was only 25 percent.