564: ANALYSIS OF OBSTETRIC TRANSPORTS TO LABOR AND DELIVERY REQUIRING ESCALATION OF CARE TO THE ICU

Abstract

Introduction: Severe maternal morbidity (SMM) is increasing. Prevention of maternal adverse outcomes requires prompt identification of the critically-ill patient requiring intensive care services (ICU). We aim to describe perinatal risk factors that are associated with obstetric transports that require escalation to the ICU after admission. Additionally we sought to illustrate the time intervals from labor and delivery (L&D) admission to the ICU as a marker for potential improvements in delays in care. Methods: This is a retrospective observational study of obstetric transports to a single tertiary medical center from 01/1/2017-12/31/2021. We included all patients transported to L&D. Patient transported directly to the ICU were excluded. Electronic medical records were used to collect demographics, obstetric and maternal risk factors, the time and indication for escalation to the ICU, and hospital length of stay (LOS). Results: A total of 1,855 obstetric transport patients were reviewed during the study period. Of these, 1,794 patients were directly admitted to L&D with 52 patients requiring escalation to the ICU during their admission. Asthma (26.9%), hypertension (21.2%) and diabetes (21.2%) were the most common maternal co-morbidities. The most common indication for ICU admission was acute respiratory failure (51%), followed by preeclampsia/eclampsia (19%), and cardiomyopathy (11.5%). Primary ICU interventions required were mechanical ventilation (59%) and vasopressors (42%). There was 1 maternal death. The time from L&D admission to ICU escalation was 35.6 hours with the median ICU LOS and total hospital LOS were 3 and 9.7 days, respectively. Conclusions: Transported obstetric patients admitted initially to L&D are still requiring ICU escalation. Delays in appropriate level of care can attribute to SMM and adverse perinatal outcomes. For this reason, obstetric-risk assessment tools are necessary in identifying the critically-ill obstetric patient to assist in determine the appropriate hospital disposition upon transfer.