Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center
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Objective Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiarycare center, comparing those patients by time period and place of delivery, and to verify clinical utility of acutephysiology 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 placeof delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used toevaluate 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 mostcommon 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 showedarea 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 postpartumhemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.
Abstract
Objective Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiarycare center, comparing those patients by time period and place of delivery, and to verify clinical utility of acutephysiology 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 placeof delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used toevaluate 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 mostcommon 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 showedarea 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 postpartumhemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.
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