A 9–year audit of obstetric patients admitted to the intensive care unit

Objective To assess etiology and risk factors of obstetric patients of admitted to the Intensive Care Unit, First Affiliated Hospital of Kunming Medical University. Methods One hundred and seventy–four cases of obstetric patients admitted to the Intensive CareUnit during pregnancy or in the postpartum period were retrospectively classified into three groups: maternal without life–threatening conditions (WLTC), maternal near–miss (MNM), and maternal death (MD), according to their outcomes. The indicators for obstetrical criteria were evaluated. Chi–square test and Yates correlated formula were used for statistical analyses. Results Among the 174 patients, 6 patients(3.4%) were deceased, 130 cases (74.7%) were maternal near–miss, and 38 cases (21.8%) were in without potentially life–threatening conditions. Main clinical manifestations of MNM were infusion of erythrocyte suspension≥5 U(26.9%,35/130), hysterectomy due to hemorrhage or infection (14.9%,19/130), pulse oximetry lower than 90% for more than one hour (14.6%, 19/130), jaundice in severe preeclampsia (10.0%, 13/130) and uncontrollable convulsions (7.7%, 10/130). Main complications of MNM were maternal hypertension (including preeclampsia, severe preeclampsia and hemodialysis, elevated liver enzymes and low platelet levels syndrome), which was 36.1%(47/130), following by obstetrical hemorrhage (28.5%, 37/130) and heart diseases (13.8%, 18/130). Maternal mortality rate was 0.224‰, incidence rate of MNM was 4.9‰, MNM/maternal death was 21.7 : 1, and the death index was 4.4%. Multiparity, previous caesarean section and jobless in life–threatening (LTC, i.e. MD+ MNM) group were higher than those in the WLTC group [16.2%(22/136) vs 0.0%(0/38), χ2=5.648; 61.0%(83/136) vs 34.2%(13/38), χ2=7.587; 85.3%(116/136) vs 55.2%(21/38), χ2=14.225; all P 7 days, caesaraen section and preterm delivery in LTC group were higher than those in WLTC group [68.4%(93/136) vs 7.8%(3/38), χ2=41.526; 19.1%(26/136) vs 0.0%(0/38), χ2=7.103; 58.1%(79/136) vs 7.9%(3/38), χ2=28.050; 70.6%(96/136) vs 42.1%(16/38), χ2=9.301; 87.5%(119/136) vs 50.0%(19/38), χ2=23.220; 63.0%(85/136) vs 39.5%(15/38), χ2=5.535; all P<0.05]. Conclusions Hypertensive disorders in pregnancy and obstetric hemorrhage are main causes for obstetric patients admitted to the ICU. Multiparity, previous caesarean section and jobless are risk factors of obstetric patients admitted to the ICU. Key words: Intensive care units; Hypertension, pregnancy–induced; Postpartum hemorrhage; Critical illness; Pregnancy outcome