Clinical characteristics of critically ill obstetric patients in intensive care unit: analysis of 476 cases

Abstract

Objective To explore the clinical characteristics of critically ill obstetric patients in intensive care unit (ICU) and the short-term perinatal outcomes. Methods The clinical data of 476 critically ill obstetric patients in ICU, who delivered in the Third Affiliated Hospital of Guangzhou Medical University from June 2009 to June 2014, were retrospectively analyzed. All subjects were divided into obstetric related diseases group (Group 1) and non-obstetric related diseases group (Group 2) according to the reasons for ICU admission. The perinatal outcomes of the two groups were compared by Wilcoxon-test and Chi-square test. Results Totally, 476 critically ill obstetric patients were transferred to ICU accounting for 1.71% of all deliveries during the 5-year period (476/27 836), with the mean age of (29.04±5.77) years and the mean gestational age of (32.00±5.63) weeks. Among them, 261 women were assigned to Group 1 (54.83%) and 215 to Group 2 (45.17%). The first three reasons for ICU admission in Group 1 were hypertensive disorder complicating pregnancy (35.29%, 168/476), postpartum hemorrhage (11.97%, 57/476) and acute fatty liver of pregnancy (2.31%, 11/476) and those in Group 2 were pregnancy with acute severe hepatitis (7.56%, 36/476), pregnancy with severe pneumonia 5.67%(27/476) and pregnancy with congenital heart disease (3.57%, 17/476) and pregnancy with acute severe pancreatitis (3.57%, 17/476) tie for the third place. The average age and the proportion of irregular prenatal care of the patients in Group 1 were both higher than those in Group 2 [(30.02±5.62) vs (27.85±5.75) years, Z=4.198, P=0.000; 75.86% (198/261) vs 61.40% (132/215), χ2=11.603, P=0.001]. More than half of the pregnant women ended in emergency cesarean section (56.71%,148/261) in Group 1, while the most common delivery mode was elective cesarean section in Group 2 when patients were clinically stable (45.58%, 98/215) (χ2=21.990, P=0.000). The mortality rate in Group 1 was lower [1.53%(4/261) vs 6.98%(15/215), χ2=9.118], but the rates of hysterectomy [15.33%(40/261) vs 0.93%(2/215), χ2=30.367, P=0.000] and neonatal asphyxia were higher than in Group 2 [36.17%(102/282) vs 22.62%(50/221), χ2=10.781, P=0.001]. Conclusions The reasons for ICU admission of critically ill obstetric patients are diverse and patients have a high mortality rate. Pregnant women with obstetric related diseases should be terminated timely and those with non-obstetric related diseases should be conceived after disease control and closely monitored during pregnancy. Key words: Intensive care units; Critical illness; Pregnant women