///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Maternal critical care admissions: clinical characteristics and outcomes in an Obstetric High Dependency Unit (OHDU) in Colombia, Latin America.

Abstract Number: 85
Abstract Type: Original Research

GERMAN MONSALVE ANESTHESIOLOGIST1 ; GONZALO ARANGO ANESTHESIOLOGIST2; JUAN GONZALEZ ANESTHESIOLOGIST3; LEONARDO MOJICA ANESTHESIOLOGIST4; MARIA V GONZALEZ ANESTHESIOLOGIST5; MAURICIO VASCO ANESTHESIOLOGIST6

OBJECTIVES: To review a group of critically ill pregnant patients admitted to an OHDU. We describe diagnoses at admission, clinical conditions, main causes of morbidity and mortality, interventions and length of stay at the unit.

DESIGN: Retrospective, chart review that includes pregnant patients until the 42nd postpartum day admitted between November 1st 2005 to November 30th 2008.

RESULTS: 819 patients (Age 28. 2 + 7.6 years, gestational age 31 + 4 weeks) (mean + SD) of 24.749 births were included. The overall OHDU admission rate was 3.3 % (3.309 admissions per 100.000 deliveries). APACHE II score was 9.13 + 6.2 (mean + SD) with 11.62% of predicted mortality; standardized mortality ratio was 0.07. 64% of the patients were admitted antepartum.

Obstetric conditions were responsible for 671 admissions (82%) mainly severe preeclampsia including HELLP syndrome 50.5% and hemorrhage 23.2%. Preexisting cardiac disease was the main non obstetrical cause of admission. Interventions included invasive blood pressure 601(73.5%), central venous pressure 221 (27.05%), pulmonary artery catheter 45 (5.4%), mechanical ventilation (MV) 51 (6.2 %) and renal replacement therapy in 16 (1.95%).

The average length of stay at the unit was 58 hours (24-360). 9 patients were transferred to a polyvalent ICU; the main reason was need for prolonged MV, or to be evaluated for other subspecialties.

There were 7 maternal deaths (0.85%) with an APACHE II 29.5 + 2.4 (mean + SD).The main cause was multiple organ dysfunction originated in hemorrhagic events in 57%, amniotic fluid embolism 14.2%, septic shock secondary to abortion 14.2% and acute fatty liver of pregnancy 14.2%. All the patients were admitted at the unit in the postpartum or post abortion period. Perinatal deaths were 42 corresponding to 8% from the total of patients admitted antepartum.

DISCUSSION: The reported incidence of admission to the ICU varies between 0.17 and 2.6 per 1000 deliveries. There are a few reports in obstetric ICU admissions from developing countries showing mortality rate ranged from 28 to 60%. Notwithstanding this incidence, we dont have information about the incidence of the need of critical care in obstetrics patients in Colombia.

The main finding in our study was that using the concept of lower admission threshold, expressed as number of admissions per 100,000 deliveries, allows us to obtain better results expressed like low values of morbidity, mortality and minor length of stay. As previously shown in most reports of critically ill obstetric patients, APACHE II score overpredicted mortality.

The use of designed services for critical care exclusively for the pregnant patient is very useful in developing countries with high values of maternal mortality and morbidity.

Mortality continues being associated with severe hemorrhage and the efforts in an adapted handling of these cases must be priority.

REFERENCES:

1. Crit Care Med 2004; 32(6):1294

2. Anaesthesia 2008;63:1081

SOAP 2009