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

Abstract

Objective: 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 commonnon-obstetric causeof admissionwas cardiacdisorder (16, 12%). Ninety-eight patients (73.7%) came from non-urban areas. We comparedpatients fromnon-urbanareasversusurbanareas: AcutePhysiology 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, whichmay in turn significantly improvematernal outcomes. Health disparities existed between patients from non-urban versus urban areas: the formerwas sicker at admission, received less standardprenatal care,weremore frequently transferred fromotherhospitals, received more interventions, developed more complication, and suffered a higher rate ofmaternalmortality.