Clinical characteristics and outcomes of obstetric patients requiring ICU admission: a 5-year retrospective review

Abstract

Clinical characteristics and outcomes of obstetric patients requiring ICU admission: a 5-year retrospective review Min Zhang1 , Zhan-Hong Tang1 , Han-Chun Wen1 , Ying-Lin Wu1 , Xing-Xin Gao2, * 1Department of Critical Care Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi, P. R. China 2Department of Burns and Plastic, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi, P. R. China *Correspondence: 11500315@163.com (Xing-Xin Gao) DOI:10.31083/j.ceog.2021.01.2124 This is an open access article under the CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0/). Submitted: April 29, 2020 Revised: August 09, 2020 Accepted: August 15, 2020 Published: February 15, 2021 Objective: To investigate the clinical characteristics and outcomes of obstetric patients requiring intensive care unit (ICU) admission in a tertiary hospital. Methods: We retrospectively analyzed the clinical data of all pregnant/postpartum patients admitted to a tertiary ICU from January 2014 to December 2018. Result: One hundred and thirty-three obstetric patients were analyzed. Most patients (114, 85.7%) were admitted postpartum, and 57.9% (n = 77) of ICU admissions were from obstetric causes. The most common obstetric cause of admission was obstetric hemorrhage (32, 24.1%), followed by pregnancy-associated hypertension (25, 18.8%). The most common non-obstetric cause of admission was cardiac disorder (16, 12%). Ninety-eight patients (73.7%) came from non-urban areas. We compared patients from non-urban areas versus urban areas: Acute Physiology and Chronic Health Evaluation (APACHE) II, 8.35 ± 3.14 versus 6.43 ± 2.59 (P = 0.002); standard prenatal care, 62.3% versus 90.3% (P = 0.004); transferred from another hospital, 25.5% versus 2.9% (P = 0.004); blood transfusion, 48% versus 22.9% (P = 0.010); plasmapheresis, 11.2% versus 0% (P = 0.039); multiple-organ dysfunction syndrome, 30.6% versus 11.4% (P = 0.026); mortality, 10.2% versus 2.9% (P = 0.176). Total maternal mortality in ICU was 8.3% (n = 11). The fetal mortality rate was 10.9% (n = 15). Conclusions: A multidisciplinary team approach is essential to improve the management of obstetric hemorrhage, hypertensive disorders and cardiac disorders, which may in turn significantly improve maternal outcomes. Health disparities existed between patients from non-urban versus urban areas: the former was sicker at admission, received less standard prenatal care, were more frequently transferred from other hospitals, received more interventions, developed more complication, and suffered a higher rate of maternal mortality. Keywords Intensive care; Maternal mortality; Obstetrics; Urban areas; Non-urban