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Obstetric admissions to major urban academic medical center intensive care units: a 6 year review
Abstract Number: S 3
Abstract Type: Original Research
Although relatively uncommon, severe pregnancy induced disease or life threatening illness coincidental with pregnancy may require specialized intensive care for some women. This study examines utilization of the intensive care units resources by pregnant women over a 6 year period at a major urban academic medical center.
Objective: To review all pregnant women who required admission to major urban academic medical center Intensive Care Units (ICU) during pregnancy, childbirth or within 2 weeks postpartum.
Study Design: Retrospective chart review study in a tertiary care center. The records of all obstetric ICU admissions from January 1, 2005 to December 31, 2010 were reviewed.
Results: Over these six years 144 women required ICU admission (0.004% of all deliveries, 0.01% of all adult ICU admissions). The mean age was 30 years. 31% of the women were of Hispanic ethnicity, 20% White, 19% Black, 4% Asian, and 26% Other(probably not coded). Most of the women (64%) were admitted to the ICU postpartum. Obstetric hemorrhage (28%) and cardiac disease (23%) were the two most common reasons for admission. Together with hypertension, respiratory disorders, and infection, these accounted for close to 90% of all admissions. Preexisting medical conditions were present in 33% of all admissions; most common was obesity (16%) and cardiac disease (8%). Prolonged ventilation and/or inotropic support were generally not required. The most common intervention was arterial line insertion (80%) and mechanical ventilation for less than 24 hours (60%). Maternal mortality was 6%.
Conclusion: Postpartum hemorrhage and cardiac disease were the most common causes of admission to our hospital’s Intensive Care Units. However, almost uniformly in both developed and developing countries, the second most common cause of admission to ICU was hypertensive disorders of pregnancy. It is possible that since in our tertiary/quaternary care hospital antihypertensive infusions and arterial and central venous line placement and monitoring can be performed in the high risk labor and delivery suite, a major indication/trigger for ICU transfer is the requirement for ventilator support or pulmonary artery catheter monitoring, hence we do not see as many ICU admissions for hypertensive disorders of pregnancy. The admission rate to intensive care may be reduced by improving medical therapy of cardiac disease and educating the patients about the risks of pregnancy with congenital heart disease or cardiomyopathy.
1. Keizer JL, Zwart JJ, Meerman RH, Harinck BI, Feuth HD, van Roosmalen J. Obstetric intensive care admissions: a 12-year review in a tertiary care centre. Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct;128(1-2):152-6
2. Al-Suleiman SA, Qutub HO, Rahman J, Rahman MS. Obstetric admissions to the intensive care unit: a 12-year review. Arch Gynecol Obstet. 2006 Apr;274(1):4-8