Clinical Characteristics and Outcomes of Obstetric Patients Requiring ICU Admission
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- Category: Vol. 78, December 2010
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Clinical Characteristics and Outcomes of Obstetric Patients Requiring ICU Admission, AHMAD H. MOWAFY and KARIM S. MASHHOUR
Abstract
Introduction & Objectives: Critically ill obstetric patients represent unique characteristics, whose management is chal-lenged by the presence of a fetus, an altered maternal physi-ology, and diseases specific to pregnancy. Despite therapeutic advances during this century, maternal mortality remains an important public health problem. So it was logic to study these patients who were referred from the Gynecology and Obstetric Department to our ICU aiming to review a series of these patients in order to assess the spectrum of diseases, required interventions, complications which occurred and maternal mortality and to identify conditions associated with maternal death.
Study Design: A retrospective cohort study in the Critical Care Medicine Department, Cairo University. The medical records of all obstetric ICU admissions over the period from January 2002 to December 2006 were reviewed.
Results: Over these 5 years, 169 women required ICU admission (1.6% of all ICU admissions). The mean age was 29.29±6.06 years; mean gestational age was 34.56±3.01 weeks, and the mean length of ICU stay was 3.32±3.6 days. Most of patients (77%) were admitted with obstetric cause, the most common cause of maternal morbidity was pregnancy-induced hypertension (56.21%), followed by obstetric hemorrhage (17.75%). Heart failure (13.6%) was the principal non-obstetric cause. Maternal mortality rate was 4.14%, with hypovolemic shock and MODS (71.4%) as main causes. Although the incidence of death was higher among patients with obstetric vs non obstetric cause (4.6% & 2.6%, respectively), this was not statistically significant (p=0.91). Twenty-five percent of patients had prior medical diseases, 76.74% of them had
Abbreviations:
ARF = Acute renal failure.
ARDS = Adult respiratory distress syndrome. ETT = Endotracheal tube.
ICU = Intensive care unite.
Mg = Magnesium.
MODS = Multiple organ dysfunction syndrome. NTG = Nitroglycerine.
RBCs = Red blood cells.
cardiac problem. The most common interventions were central venous catheterization (91.1%), ET intubation (16.6%), and mechanical ventilation (12.4%). Disturbed conscious level, MODS, shock, ARF, bleeding, and ARDS were present in 17.8%, 12.4%, 10.7%, 10.7%, 8.9% and 7.1% of patients, respectively. Anemia, leucocytosis, and thrombocytopenia were more present in the obstetric group. The most common ICU therapy was NTG (56.21%), Mg sulphate (25.44%), packed RBCs (21.9%), and vasoactive drugs (12.4%).
Conclusions: The admission rate to the ICU may be reduced by improving the management of the hypertensive disease during pregnancy and by reducing the incidence of hemorrhagic complications. Early admission to the ICU decreases the maternal mortality and morbidity. Physicians in the ICU should be familiar with the complications of pregnancy and should work closely with obstetricians. Despite several complications which occurred with obstetric patients, the prognosis is still good.