Maternal critical care in obstetrics.
OBJECTIVE
To determine the factors leading to maternal critical care in a tertiary obstetric hospital and the associated trends.


METHODS
We conducted a review of the medical records of all women who required transfer for critical care from a free-standing obstetric unit to a general hospital over a 24-year period (1982-2005).


RESULTS
During the 24-year period there were five maternal deaths directly associated with 122,001 deliveries (4.1/100,000) and, in addition, 117 women were transferred to the general hospital for critical care (1.0/1000). The death-to-transfer ratio was 1 in 23. Of the women transferred, 93/117 (79.5%) required intensive care and 24/117 (20.5%) needed specialized medical or surgical services not available in the obstetric unit. Of the women transferred, 16/117 (13.7%) were antepartum, and 101/117 (86.3%) were postpartum. Hemorrhage and hypertensive disorders combined to make up 56.4% of all maternal transfers. Women with a multiple pregnancy were more likely to require transfer than those with a singleton pregnancy (RR 3.34; 95% CI 1.4-7.59, P=0.01).


CONCLUSIONS
The majority of maternal transfers for critical care occur postpartum, and in more than half of the cases the reason for transfer is hemorrhage or hypertensive disease. Women with a multiple pregnancy had a significantly greater rate of transfer than those with a singleton, and women with a triplet pregnancy had a greater rate than those with twins. There was a non-significant increase in the number of maternal transfers over the study period.
Baskett
Thomas F
TF
Department of Obstetrics and Gynaecology and Perinatal Epidemiology Research Unit Dalhousie University, Halifax NS.
O'Connell
Colleen M
CM
Department of Obstetrics and Gynaecology and Perinatal Epidemiology Research Unit Dalhousie University, Halifax NS.
D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D009674:Nova Scotia / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011644:Puerperal Disorders / Q000453:epidemiology*