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Etiology of ICU Admission in Obstetric Patients Differs by Mode of Conception
Abstract Number: F4B-5
Abstract Type: Original Research
Background: The use of in-vitro fertilization (IVF) is becoming increasingly widespread. The incidence of adverse outcomes is greater for those who underwent IVF and may lead to intensive care unit (ICU) admission. The etiology of ICU admission in the IVF population as compared to those who conceived spontaneously has not been well studied.
Methods: In this retrospective study, medical records of patients admitted to the ICU while pregnant or within 6 weeks postpartum at our institution from 2005-2016 were analyzed. Demographic, past medical and obstetric history, as well as mode of conception (IVF vs spontaneous) for the current pregnancy were collected. Details of their delivery and ICU stay including reason for ICU admission were analyzed. Differences between groups were compared with chi squared tests for categorical variables, t-tests for continuous variables, and binary logistic regression was performed on those variables that were statistically significant in the univariate analysis. P < 0.05 was considered significant.
Results: During the study period there were 78,127 deliveries of which 208 (0.27%) patients were admitted to the ICU. Of the 208, 28 (13.5%) were IVF pregnancies. Patients in the IVF group were older (median age 36 vs. 32), had lower parity (median 0 vs 1), were more often Caucasian (64.3% vs 39.4%), and less likely to have any non-obstetric medical history (46.4% vs 71.1%). They were also more likely to have multiple gestations (50% vs 6.1%). Reasons for ICU admission differed significantly between groups (p=0.012). In the IVF group, 85.7% were admitted due to a complication related to the pregnancy vs. 62.7% in the non-IVF group. The most common reason in both groups was postpartum hemorrhage (PPH) followed by cardiovascular disease (Table 1). The IVF patients had a nearly doubled incidence of hemorrhagic shock (60.7% vs 36.1% p=0.012) and increased incidence of hysterectomy (42.8% vs 30.6% p=0.012). The increased incidence of PPH was independent of age and multiple gestations in the IVF group.
Conclusions: The etiology of ICU admission differs by mode of conception. For patients with IVF pregnancies, hemorrhage is the most common reason, but for patients with spontaneous pregnancies, hemorrhage accounts for less than 50%, with greater contribution from indirect medical etiologies. Furthermore, the acuity of the PPH may be more severe in IVF patients as evidenced by an increased incidence of hemorrhagic shock and hysterectomy.