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Trends in Obstetric Critical Care
Abstract Number: SA-33
Abstract Type: Original Research
Introduction: Due to improvements in achieving fertility, an aging maternal population and advanced treatment of diseases, we now care for parturients with complex co-morbidities. Care for the critically ill maternal population is facility specific and driven by resources available to the providers. However, there may be some commonalities in practice to offer insight into how to better care for the critically ill obstetric patient. We sought to determine how frequently high dependency units (HDU) versus intensive care units (ICU) are utilized to care for critically ill parturients and how these units are staffed and modeled.
Methods: Following a review of literature on critical care in the maternal population, we developed a twenty-five-question survey to assess facility, HDU and ICU demographics. The questionnaire was distributed via email and electronic survey to all active members of SOAP.
Results: Survey response rate was 17%, with the majority practicing in large, academic, tertiary referral centers. Only 41% reported utilization of an HDU for obstetric patients, with 53% of these HDUs being embedded within the labor and delivery unit. A majority of HDUs provide arterial line monitoring, telemetry, and drug infusions with 82% reporting anesthesiologist involvement in management. Regarding ICU models, 89% of responders do not adhere to strict criteria for ICU admission. 58% of providers utilize an open model. Responders were divided on MICU vs. SICU admission (54% vs. 46%, respectively).
Conclusion: Significant practice variation exists in caring for the critically ill parturient, with little guidance regarding best practices. HDUs, although recommended for the critically ill parturient not requiring ICU admission, do not exist in a majority of tertiary referral centers. Improved outcomes have been demonstrated with a closed ICU model, but most critically ill obstetric patients are admitted to an open ICU. The majority of obstetric ICU admissions are due to hemorrhage and pre-eclampsia, but over half of responders report admission to the MICU, where competencies do not include management of obstetric or surgical patients. Further investigation is required to determine best practices for management of the critically ill parturient.
Jan 2016.Practice Bulletin No.158:Critical Care in Pregnancy.[https://access.acog.org/eweb]; 127(1):e21-8.
Zeeman G, et al. A blueprint for obstetric critical care. Am J Obstet Gynecol. 2003; 188:532-6.