Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center.
10.5468/ogs.2018.61.2.209
- Author:
Hye Yeon YI
1
;
Soo Young JEONG
;
Soo Hyun KIM
;
Yoomin KIM
;
Suk Joo CHOI
;
Soo young OH
;
Cheong Rae ROH
;
Jong Hwa KIM
Author Information
1. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ohsymd@skku.edu
- Publication Type:Original Article
- Keywords:
Intensive care units;
Maternal death;
Postpartum hemorrhage;
Amniotic fluid embolism;
Acute physiology and chronic health evaluation (APACHE)
- MeSH:
APACHE;
Critical Care*;
Embolism, Amniotic Fluid;
Female;
Humans;
Hysterectomy;
Incidence;
Intensive Care Units*;
Maternal Age;
Maternal Death;
Maternal Mortality;
Mortality;
Postpartum Hemorrhage;
Pregnancy;
Retrospective Studies;
ROC Curve;
Sepsis;
Tertiary Care Centers*;
Tertiary Healthcare*
- From:Obstetrics & Gynecology Science
2018;61(2):209-219
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women. METHODS: Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994–2004; period 2: 2005–2015) and place of delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used to evaluate the usefulness of APACHE II score to predict maternal mortality. RESULTS: During 22-year period, 176 women required ICU admission, showing the incidence of 2.2 per 1,000 deliveries. The most common reason for ICU admission was postpartum hemorrhage (56.3%), followed by hypertensive disorders (19.3%), sepsis (3.4%), and pulmonary and amniotic fluid embolism (2.3%). Period 2 showed older maternal age (32.7±4.8 vs. 30.8±4.4 years, P=0.006, higher embolization rate (26.4% vs.1.2%, P < 0.001), and lower hysterectomy rate (30.8% vs. 49.4%, P=0.012). Cases from local hospitals showed significantly higher proportion of postpartum hemorrhage (84.5% vs. 42.2%, P < 0.001). Overall maternal death occurred in 5.1% (9/176) including 6 direct maternal deaths. The APACHE II score showed area under the ROC curve of 0.813 (confidence interval [CI], 0.607–1.000) for prediction of maternal mortality. CONCLUSION: The incidence of obstetric ICU admission was 2.2 per 1,000 deliveries and the most common reason was postpartum hemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.
