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Maternal morbidity – an analysis of High Dependency Unit care in pregnant or recently pregnant women
Abstract Number: SA-35
Abstract Type: Original Research
Introduction: Pregnant women may become critically unwell with estimates of one intensive care unit (ICU) admission for every 370 births. Obstetric complications in previously healthy women contribute the majority of these admissions. The main causes of critical care admissions are hypertensive disorders & obstetric hemorrhage. Maternal mortality rates have been decreasing worldwide but maternal morbidity remains unreported with best estimates suggesting that 1 in 200 pregnant women suffer a significant complication. High dependency unit(HDU) care is an important level of care between standard(low acuity) ward care & intensive unit(high acuity) care. We aimed to determine the number of obstetric women receiving HDU care (1 nursing staff:2 patients) in our unit, the major reasons for obstetric admissions & to assess the interventions received.
Method: After IRB approval, a 5-year retrospective analysis (July 1 2008–June 30 2013) was undertaken at our a tertiary referral obstetric centre (>6000 births per year). This time period corresponded with the colocation of this hospital with a tertiary referral adult non-obstetric hospital.
Results: There were 31,848 births & 632 women admitted to HDU (~1 in 50 births). 55% of women were transferred from the postoperative care unit to HDU. Mean±SD age was 32±5.9 years. The commonest cause for admission was obstetric hemorrhage (39%)(Table). The commonest monitoring intervention was intra-arterial blood pressure monitoring(45%). Only 36(6%) women received a central venous catheter. The mean±SD length of stay was 35±42.9 hours with 610(97%) women being transferred from HDU to lower acuity care & only 22(3%) women requiring transfer to higher acuity care (coronary care unit or ICU). There were no maternal deaths. 103(16%) women were admitted for postoperative monitoring due to complicated surgery, for miscellaneous medical or surgical conditions or because of pre-existing comorbidities.
Conclusions: Our data suggests that admission to HDU is 7 times more common than admission to ICU but the maternal morbidity leading to admission; hemorrhage, hypertension, cardiac disease & sepsis, is similar in both settings. In HDU 1 in 6 women admitted are stable but require closer monitoring usually with an arterial line. Most women are discharged within a short period of time to standard ward based care.Hospital based educational programs need to focus on the 4 major causes of morbidity, their diagnosis & optimal management.