title: Epidemiology of obstetric-related ICU admissions in Maryland: 1999-2008*.
abstract: OBJECTIVE
  To define the prevalence, indications, and temporal trends in obstetric-related ICU admissions.
  
  
  METHODS
  Descriptive analysis of utilization patterns.
  
  
  METHODS
  All hospitals within the state of Maryland.
  
  
  METHODS
  All antepartum, delivery, and postpartum patients who were hospitalized between 1999 and 2008.
  
  
  METHODS
  None.
  
  
  RESULTS
  We identified 2,927 ICU admissions from 765,598 admissions for antepartum, delivery, or postpartum conditions using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. The overall rate of ICU utilization was 419.1 per 100,000 deliveries, with rates of 162.5, 202.6, and 54.0 per 100,000 deliveries for the antepartum, delivery, and postpartum periods, respectively. The leading diagnoses associated with ICU admission were pregnancy-related hypertensive disease (present in 29.9% of admissions), hemorrhage (18.8%), cardiomyopathy or other cardiac disease (18.3%), genitourinary infection (11.5%), complications from ectopic pregnancies and abortions (10.3%), nongenitourinary infection (10.1%), sepsis (7.1%), cerebrovascular disease (5.8%), and pulmonary embolism (3.7%). We assessed for changes in the most common diagnoses in the ICU population over time and found rising rates of sepsis (10.1 per 100,000 deliveries to 16.6 per 100,000 deliveries, p = 0.003) and trauma (9.2 per 100,000 deliveries to 13.6 per 100,000 deliveries, p = 0.026) with decreasing rates of anesthetic complications (11.3 per 100,000 to 4.7 per 100,000, p = 0.006). The overall frequency of obstetric-related ICU admission and the rates for other indications remained relatively stable.
  
  
  CONCLUSIONS
  Between 1999 and 2008, 419.1 per 100,000 deliveries in Maryland were complicated by ICU admission. Hospitals providing obstetric services should plan for appropriate critical care management and/or transfer of women with severe morbidities during pregnancy.
authors: Department of Anesthesia, Vanderbilt University, Nashville, TN, USA. jonathan.p.wanderer@vanderbilt.edu
authors: Jonathan P
authors: JP
authors: Wanderer
authors: Lisa R
authors: LR
authors: Leffert
authors: Jill M
authors: JM
authors: Mhyre
authors: Elena V
authors: EV
authors: Kuklina
authors: William M
authors: WM
authors: Callaghan
authors: Brian T
authors: BT
authors: Bateman
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical; D044383:Black People / Q000706:statistics & numerical data; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D017093:Liver Failure / Q000453:epidemiology; D008396:Maryland / Q000453:epidemiology; D008423:Maternal Age; D008484:Medicaid / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends*; D010360:Patient Transfer; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011271:Pregnancy, Ectopic / Q000453:epidemiology; D011644:Puerperal Disorders / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology; D055815:Young Adult; D001741:Black or African American
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