241: Baseline risk assessment for peripartum maternal critical care interventions

Abstract

Identifying patients at high risk for critical care interventions during delivery hospitalizations may facilitate appropriate multidisciplinary planning and improve maternal safety. This study assessed factors associated with critical care interventions that were present at admission for delivery. This is a secondary analysis of a multi-center observational registry of delivery after prior uterine scar. All women with a known delivery date were included. Risk for the primary outcome, a composite of critical care interventions that included postpartum ICU admission, mechanical ventilation, and central or arterial line placement, was compared by selected baseline and obstetric characteristic known at admission, including maternal age, pre-pregnancy BMI, race, maternal co-morbidities, parity, and plurality. We evaluated these potential predictors and fit a multivariable logistic regression model to ascertain the most important risk factors for critical care during a delivery hospitalization. Predictors were ultimately selected from the model with the best goodness-of-fit. 73,096 of 73,257 women in the parent trial met inclusion criteria, of whom 505 received a critical care intervention (0.7%). In the adjusted model, heart disease [aOR 10.05, CI 6.97 - 14.49], renal disease [aOR 2.78, CI 1.49 - 5.18], and connective tissue disease [aOR 3.27, CI 1.52 - 6.99], as well as hypertensive disorders of pregnancy [aOR 2.04, CI 1.31 - 3.17] were associated with the largest odds of critical care intervention [p <0.01] (Table 2). Other predictors associated with increased risk included maternal age, African American race, smoking, diabetes, asthma, anemia, nulliparity, and twin pregnancy. In this cohort, women with heart disease, renal disease, connective tissue disease or preeclampsia spectrum disorders were at increased risk for requiring critical care interventions. Obstetric providers should assess patient risk routinely, ensure appropriate maternal levels of care, and create multidisciplinary plans to improve maternal safety and reduce risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)