Study objectives: To determine the incidence of
systemic inflammatory response syndrome (SIRS) and organ failure and to
describe the outcomes in critically ill obstetric patients who have
been treated in medical ICUs.
Setting: A multidisciplinary ICU at a
Methods: We collected data
on 74 obstetric patients who were admitted consecutively to the ICU
from January 1991 through December 1998. Acute physiology and chronic
health evaluation (APACHE) II scores were calculated. A p value< 0.05 was considered to be significant.
results: Fifty-eight percent of patients were admitted to the ICU
postpartum. Their mean (± SD) age was 25.9 ± 7.0 years, and 64%
were African American and 34% were white. Fifty percent had
preexisting medical conditions. Their mean APACHE II score was
14.0 ± 5.9, and their predicted mortality rate was 17.6%. The most
common reason for admission was respiratory insufficiency. Preeclampsia
was present in 38% of patients, and hemolytic anemia, elevated liver
enzymes, and low platelet count syndrome were present in 7% of
patients. SIRS developed in 59% of patients. Patients with SIRS had
longer ICU stays (p = 0.0008). Organ failure developed in 65% of
patients, and ARDS developed in 15% of patients. Invasive mechanical
ventilation was required in 45% of patients, and pulmonary artery
catheterization was required in 35% of patients. The in-hospital
mortality rate was 2.7%. There were five spontaneous abortions and
eight perinatal deaths.
Conclusions: The most common
reason for admission to the ICU of critically ill obstetric patients
was respiratory failure. Despite the severity of illness and the
development of SIRS and organ failure in most patients, the mortality
rate was low.