PURPOSE: Obstetric patients present a unique challenge to the intensivist. For example, pregnant and postpartum women have altered physiology specific to pregnancy and present with diseases found only in pregnancy. The purpose of our study was to describe obstetric admissions to the intensive care units (ICUs) at a tertiary care hospital.
METHODS: Rhode Island Hospital (RIH), an affiliate of Brown Medical School, serves as a major tertiary care center for the state of Rhode Island. We retrospectively reviewed obstetric admissions to all intensive care units at RIH from 10/2001 to 10/2004. Patients were identified through a medical billing search. Data collected included age, race, preexistent medical problems, days in the ICU and Acute Physiology and Chronic Health Evaluation II score (APACHE II).
RESULTS: We identified 93 obstetric ICU admissions. The average age was 29.3. 55% of women were white and 17% were black. 47% had a major preexistent medical problem including asthma (n=18), hypertension (n=10), and diabetes (n=6). 57% were admitted antepartum. Mean length of ICU stay was 4.5 days. Mean APACHE II score was 11.3. Indications for ICU admission included respiratory insufficiency (40%), hemodynamic instability (24%), neurological dysfunction (13%), major trauma (6%), post-surgical observation (3%) and other (14%). Cardiac diseases, including postpartum cardiomyopathy and supraventricular tachycardia, were the most common underlying diagnoses (17%). 65% of admissions were for non-obstetric causes. 18% had preeclampsia. One patient in our series died.
CONCLUSION: Our findings support other data which identify cardiac disease as an increasingly important cause of maternal mortality. In addition, we found a significant proportion of patients (20%) had a past history of asthma. Finally, a disproportionate number (17%) of our total population was black.
CLINICAL IMPLICATIONS: A better understanding of the characteristics of pregnant and postpartum patients who require ICU admission is the first step in developing better models for their care.
DISCLOSURE: Anna Rudnicki, None.