PURPOSE: Intensive care unit (ICU) admission rate for obstetric patients in developed countries ranges from 4/1,000 to 9/1,000 deliveries. Common causes of admission are obstetric related complications and exacerbation of a co-morbid condition. To compare obstetric patients admitted to ICU with a non-ICU obstetric control group.
METHODS: Retrospective chart review of all obstetric patients admitted to ICU from January 2004 to December 2007, matched control group (1:2) included patients admitted on the same date to obstetric floor.
RESULTS: We reviewed 149 charts, 50 ICU and 99 non-ICU. Average age was 28. There were more African Americans in ICU (52%) and more Hispanics (56%) in the control group. The most common admission diagnoses in the ICU were asthma exacerbation, postpartum hemorrhage, eclampsia/preeclampsia and diabetic ketoacidosis. ICU patients had higher Apache II score (p<0.001) and four times higher length of stay (LOS) (p<0.004). Number of blood product transfusion was higher for the ICU group (p<0.0001). Comorbidities associated with ICU admission included hypertension (OR 2.8, CI 1.04–7.7), respiratory disease (OR 3.4, CI 1.43–8.2) or substance abuse (OR 2.8, CI 0.81–11.9). There were no differences between the two groups in frequency of antenatal care, gestational age or maternal mortality. The ICU admission rate at our institution is 6/1,000 deliveries. There were 4 (8%) and 2 (2%) fetal death in the ICU and non-ICU group respectively.
CONCLUSION: Hypertension and pulmonary disease are important predictors of ICU admission in the obstetric population. Illicit drug use may also increase the risk of ICU admission. The ICU admission rate is higher than reported in developed countries, but maternal and fetal mortality in an inner city community hospital is similar to the reported in the literature.
CLINICAL IMPLICATIONS: Recognition and management of co-morbid condition in obstetric population is of the outmost importance. Education regarding medical care and avoidance of illicit drugs cannot be overemphasized. This could help to decrease morbidity and LOS.
DISCLOSURE: Andrea Feng, No Financial Disclosure Information; No Product/Research Disclosure Information