Clinical characteristics and outcomes of obstetric patients requiring ICU admission.
OBJECTIVE
To review a series of critically ill obstetric patients admitted to our ICU to assess the spectrum of disease, required interventions, and fetal/maternal mortality, and to identify conditions associated with maternal death.


METHODS
Retrospective cohort.


METHODS
Medical-surgical ICU in a university-affiliated hospital.


METHODS
Pregnant/postpartum admissions between January 1, 1998, and September 30, 2005.


METHODS
None.


RESULTS
We studied 161 patients (age, 28 +/- 9 years; mean gestational age, 29 +/- 9 weeks) [mean +/- SD], constituting 10% of 1,571 hospital admissions. APACHE (acute physiology and chronic health evaluation) II score was 14 +/- 8, with 24% predicted mortality; sequential organ failure assessment score was 5 +/- 3; and therapeutic intervention scoring system at 24 h was 25 +/- 9. Forty-one percent of patients required mechanical ventilation (MV). ARDS, shock, and organ dysfunction were present in 19%, 25%, and 48% of patients, respectively. Most patients (63%) were admitted postpartum, and 74% of admissions were of obstetric cause. Hypertensive disease (40%), major hemorrhage (16%), septic abortion (12%), and nonobstetric sepsis (10%) were the principal diagnoses. Maternal mortality was 11%, with multiple organ dysfunction syndrome (44%) and intracranial hemorrhage (39%) as main causes. There were no differences in death rate in patients admitted for obstetric and nonobstetric causes. Fetal mortality was 32%. Only 30% of patients received antenatal care, which was more frequent in survivors (33% vs 6% nonsurvivors, p = 0.014).


CONCLUSIONS
Although ARDS, organ failures, shock, and use of MV were extremely frequent in this population, maternal mortality remains within an acceptable range. APACHE II overpredicted mortality in these patients. Septic abortion is still an important modifiable cause of mortality. Efforts should concentrate in increasing antenatal care, which was clearly underprovided in these patients.
Vasquez
Daniela N
DN
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina. Electronic address: danielavasquez73@yahoo.com.ar.
Estenssoro
Elisa
E
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Canales
Héctor S
HS
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Reina
Rosa
R
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Saenz
María G
MG
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Das Neves
Andrea V
AV
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Toro
María A
MA
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Loudet
Cecilia I
CI
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
D018806:APACHE; D000031:Abortion, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D001118:Argentina; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005313:Fetal Death / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011644:Puerperal Disorders / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012769:Shock / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015996:Survival Rate