title: Outcomes and trends of peripartum maternal admission to the intensive care unit.
abstract: BACKGROUND
  The number of pregnant women with severe comorbidities is increasing. The aim of the present study was to analyze outcomes and determine trends in women who required peripartum admission to the intensive care unit (ICU).
  
  
  METHODS
  In this retrospective study, we identified all women who were admitted to the ICU between the second trimester of pregnancy and 6 weeks postpartum. Women with ICU admission between 2011 and 2014 were assigned to the study group, whereas those admitted between 1996 and 2003 were assigned to the historical group. Comorbidities, characteristics, outcomes, and treatment efforts were assessed. Descriptive analysis, Fisher's exact test, unpaired Student's t-test and one-way ANOVA were performed.
  
  
  RESULTS
  We identified 238 cases, including 135 (56.7%) in the study group and 103 (43.3%) in the historical group. In 83 (34.9%) women, deterioration of the pre-existing medical condition was causal for ICU admission. Overall, preterm delivery and mean gestational age were 81.5% and 31.6 ± 6.2 weeks, respectively. In comparison to the historical group, women of the study group were older (p = 0.005), more frequently presented with multiple comorbidities (p = 0.003), pre-existing conditions (p < 0.001), and congenital heart disease (p = 0.012). Moreover, they had a shorter length of stay at the ICU than those of the historical group (p = 0.02).
  
  
  CONCLUSIONS
  Peripartum ICU admissions are increasing in frequency. As maternal characteristics are changing, adequate risk stratification with multidisciplinary care are essential, and access to intermediate care units would be preferable for patients with short-term admission.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. alex.farr@meduniwien.ac.at.
authors.forename: Alex
authors.identifier: http://orcid.org/0000-0002-4628-9052
authors.initials: A
authors.lastname: Farr
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Lenz-Gebhart
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Einig
authors.affiliation: Department of Anesthesia, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Ortner
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Holzer
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Marie
authors.initials: M
authors.lastname: Elhenicky
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Husslein
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Lehner
mesh_terms: D000328:Adult; D001317:Austria; D000075902:Clinical Deterioration; D015897:Comorbidity / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D010343:Patient Admission / Q000639:trends*; D058725:Peripartum Period; D064266:Preexisting Condition Coverage / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000628:therapy*; D011262:Pregnancy Trimester, Second; D011644:Puerperal Disorders / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Comorbidity; Intensive care unit; Mortality; Near miss; Pregnancy complication