title: Retrospective review on obstetric cases of critically ill and dead patients in Dongguan.
abstract: This retrospective analysis was set to understand the epidemiological status of the critically ill obstetric patients in Dongguan city, Guangdong, China. Understanding the risk factors for the death cases can provide scientific evidences for future preventive strategies to decrease the maternal mortality rate. This retrospective included the statistical data and clinical data on the cases of critically ill and dead obstetric patients admitted to Dongguan People's Hospital and Dongguan Maternal & Child Health Hospital from September 1st, 2009 to August 31st, 2013. Data included numbers of the critically ill maternal and obstetric women, common obstetric and maternal comorbidities and complications in the critically ill patients, the basic characteristics of maternal and obstetric deaths, records of regular prenatal examinations, the time intervals between onset of acute symptoms and ICU admission, blood purification, and the acute physiology and chronic health evaluation II (APACHE II) score. During the 5-year period, there were increasing trend of critically ill pregnant and obstetric patients, and the prevalence rate of critically ill obstetric patients was 8.99-9.28 %. The most common obstetric causes of admission were massive postpartum hemorrhage (63.54 %), followed by pregnancy-associated hypertension (15.85 %) and placenta previa (8.92 %). The most common non-obstetric causes of admission were acute heart failure (1.98 %). In the observed period, 20 critically ill obstetric patients died in these two hospitals (mortality rate 0.24 %, 20/8,129). The mean age of dead women was (30.3 ± 6.6) years old and mean gestational age was (30.1 ± 9.3) weeks. 75 % of the patient had more than two pregnancies. Over 90 % of the patients received education below junior high school level. 85 % of the patients were non-Dongguan natives and regular prenatal care rate was only 15 % on dead cases. The most common causes of death were pregnancy-associated hypertension, acute heart failure, and massive postpartum hemorrhage. The dead patients experienced longer interval between onset of acute symptoms and ICU admission (media = 62.5 h), higher APACHE II score (25.4 ± 5.4), and lower blood purification treatment rate (10 %). The incidence of critically ill pregnant and obstetric patients is high in Dongguan city. The group of dead obstetric patients, the majority of which were non-Dongguan natives, usually experienced above-average pregnancies, lower educational level, lower regular prenatal care rate, and longer interval between onset of acute symptoms and ICU admission. Critically ill obstetric patients may benefit from publicized informed relevant education, government-supported health care, preventative interventions of critical obstetric and medical complications, timely ICU admission after onset of acute symptoms, and the enhanced support of organ functions within the ICU.
authors.affiliation: Dongguan People's Hospital, Dongguan, 523000, Guangdong, China, drshenlihan@163.com.
authors.forename: Li-Han
authors.initials: LH
authors.lastname: Shen
authors.forename: Yun-Yong
authors.initials: YY
authors.lastname: Fang
authors.forename: Yan-Bing
authors.initials: YB
authors.lastname: Zheng
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Xiao
authors.forename: Su-Ran
authors.initials: SR
authors.lastname: Huang
authors.forename: Xi-Zhen
authors.initials: XZ
authors.lastname: Liu
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Cai
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009774:Obstetrics / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors