PURPOSE: To determine the spectrum of illnesses that requires medical intensive care unit (MICU) admission in obstetric patients and the outcome of these patients.
METHODS: Retrospective analysis of all pregnant and postpartum women admitted to the MICU from January 1, 2002 to March 31, 2008 in an urban tertiary care medical center that includes a women's hospital.
RESULTS: There were 54 obstetric patients that had a total of 62 admissions to the MICU during the study period. Patients were admitted postpartum (56.5%) and antepartum (43.5%). The mean age of patients was (28.5 ± 7.6) years. The majority of patients were African American (43/54, 79.6%). The main reasons for admission to the MICU were: sepsis (15/62; 24.2%), pulmonary edema (10/62, 16.1%), preeclampsia/ecclampsia (8/62, 12.9%), postpartum hemorrhage (7/62, 11.3%), status asthmaticus (4/62, 6.5%), pulmonary hypertension (3/62, 4.8%), acute abdomen (3/62, 4.8%), and miscellaneous causes such as pulmonary embolism, crack lung, intracranial bleeding, seizure, hyperemesis gravidarum, Sheehan's syndrome, DKA, Guillan-Barre Syndrome, and hypovolemic shock (12/62, 19.4%). Among the sepsis patients, the leading causes were pneumonia and pyelonephritis (5/15 each). The APACHE III score was (34.2 ± 18) with a predicted mortality rate of (32.1% ± 1.1). The mean length of stay in MICU was 6.8 days. A high number of patients required the use of mechanical ventilation (30/62, 48.4%), the majority of whom for more than 24 hours (24/30, 80%). Multiple organ system failure (MOSF) with more than 2 organ failure was noted in 18 patients (29%) while 44 patients (71%) had 2 or less organ failure. The majority of patients survived the MICU and hospital stay (52/54, 96.3%), while maternal mortality rate was low (2/54, 3.7%).
CONCLUSION: The main reasons for admission to MICU were sepsis, pulmonary edema, hypertensive disorders of pregnancy, and postpartum hemorrhage. Despite their critical illness with high APACHE III and MOSF, the maternal outcome of MICU care was favorable.
CLINICAL IMPLICATIONS: Early and aggressive MICU management leads to good outcome and low mortality rate in critically ill obstetric patients.
DISCLOSURE: Kamal Nasser, No Financial Disclosure Information; No Product/Research Disclosure Information