Obstetric intensive care admissions: A 12-year review in a tertiary care centre

https://doi.org/10.1016/j.ejogrb.2005.12.013Get rights and content

Abstract

Objective

To review all pregnant women who required admission to an Intensive Care Unit (ICU) during pregnancy, childbirth or puerperium.

Study design

Retrospective follow-up study in a tertiary care centre in The Netherlands. The files of all obstetric ICU admissions over the period 1990–2001 were reviewed.

Results

Over these 12 years, 142 women required ICU admission (0.76% of all deliveries, 0.70% of all adult ICU admissions). The most common reasons for ICU admission were (pre)eclampsia (62.0%) and obstetric haemorrhage (18.3%). Twenty-seven out of 142 women (19.0%) were of non-caucasian origin. The most common therapeutic interventions were transfusion of erythrocytes (66.2%), caesarean section (50.7%) and artificial ventilation (44.4%). We observed seven maternal deaths (4.9%).

Conclusion

We need better information about high-risk obstetric patients in order to prevent severe maternal morbidity and to improve maternal care. The high number of non-caucasian women requiring ICU admission indicates the need for a study into the role of ethnicity. We have initiated a nationwide confidential enquiry into the causes of severe maternal morbidity.

Introduction

Management of the critically ill obstetric woman at an intensive care unit (ICU) is an important part of obstetric practice. Few studies, however, give insight into which women need this specialised care. The percentage of pregnant women who require ICU admission is claimed to be 0.07–0.74% [1], [2], [3], [4], [5], [6]. The reasons for admission are mainly hypertensive disease (21–76%) and obstetric haemorrhage (15–33%). The incidence of severe maternal morbidity seems to have increased over the last decade, and therefore needs to be addressed [7].

The aim of this study was to review pregnant women who required admission to our ICU. Knowledge of near-miss maternal mortality helps to delineate the continuing threats to maternal health [8]. We intended to obtain more knowledge of the population at risk for ICU admission in our tertiary care centre.

Little information is known about the role ethnicity plays in maternal care. Bouvier-Colle et al. found non-European nationality, among other variables, to be associated with ICU admission [9]. Black race was found to be an independent risk factor for ICU admission in the UK [10]. In another study, foreign nationality was the only individual factor related to severe maternal morbidity [11]. A confidential enquiry into the causes of maternal deaths in The Netherlands indicated that immigrant women are at higher risk of maternal mortality than indigenous women [12]. These findings supported us to have a more intense look into the ethnicity of the women in our population.

Section snippets

Materials and methods

The study was conducted in Leiden University Medical Centre, one of the ten tertiary care centres in The Netherlands with 882 beds, a 30-bed ICU and an annual number of about 1500 births. We reviewed the medical records of all obstetric admissions to this multidisciplinary ICU over a 12-year-period (1990–2001). Women who stayed at the ICU only for postoperative recovery were excluded. We characterised the critically ill obstetric women with respect to the cause and time of their ICU admission.

Results

The total number of births during the study period was 18.581. ICU admission was needed in 142 women (0.76%), 27 (19.0%) of whom being non-caucasian. Ethnic origin is shown in Table 1. Thirty-nine women (27.5%) were admitted before and 98 (69.0%) after childbirth (Table 2). The remaining five were admitted for complications of early pregnancy. Thirty-four women (23.9%) were referred to our hospital after delivery. Mean age was 30 years (range 19–43). Mean length of ICU stay was 4.5 days (range

Comment

The observed percentage of pregnant women who need ICU admission is in the upper range of what is reported in the literature: 0.76% versus 0.11–0.74% [1], [2], [3], [4], [5], [6]. This can be due to referral bias: as a tertiary care centre, we received several women after birth elsewhere who were admitted to our ICU (22.5% of all ICU admissions).

In our study, 28% of ICU admissions were antepartum. This agrees with other studies, in which the mean rate of antepartum admission is 39% (range:

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