Abstract
BackgroundTo study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU).MethodsThis is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU in a provincial referral center in China from January 2014 to December 2019. The collected information included maternal demographic characteristics, indications for ICU and HDU admission, the length of ICU stay, the total length of in-hospital stay and APACHE II score. Chi-square and ANOVA tests were used to determine statistical significance. The temporal changes were assessed with chi-square test for linear trend.ResultsA total of 40,412 women delivered and 447 (1.11%) women were admitted to ICU in this 6-year period. The rate of ICU admission peaked at 1.59% in 2016 and then dropped to 0.67% in 2019 with the introduction of obstetric HDU. The average APACHE II score increased significantly from 6.8 to 12.3 (P < 0.001) and the average length of ICU stay increased from 1.7 to 7.1 days (P < 0.001). The main indications for maternal ICU admissions were hypertensive disorders in pregnancy (39.8%), cardiac diseases (24.8%), and other medical disorders (21.5%); while the most common reasons for referring to HDU were hypertensive disorders of pregnancy (46.5%) and obstetric hemorrhage (43.0%). The establishment of HDU led to 20% reduction in ICU admission, which was mainly related to obstetric indications.ConclusionsThe introduction of HDU helps to reduce ICU utilization in obstetric population.
Highlights
To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU)
Study design and settings This is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU of Nanjing Drum Tower Hospital from January 2014 to December 2019
A p value of 0.05 was used as the cut-point for significance. During this 6-year period, a total of 40,412 women delivered at the hospital and 447 women were admitted to ICU, making an overall ICU admission rate of 1.11%
Summary
To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU). Admission of pregnant or postpartum women to intensive care unit (ICU) is an indicator of severe maternal morbidity and an endpoint for clinical audit in quality of care [1]. High dependency unit (HDU) provides a level of care which lies in between a general ward and an ICU, which has been suggested to reduce the need for ICU beds [4]. Little was known about the respective roles of obstetric HDU and ICU in caring severe maternal morbidity in this region. The present study aims to study the temporal trend of ICU admission with the introduction of maternal HDU and assess the characteristics of pregnancy-related ICU and HDU admissions
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