Obstet Gynecol Sci.  2018 Mar;61(2):209-219. 10.5468/ogs.2018.61.2.209.

Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center

• Yi HY
• Jeong SY
• Kim SH
• Kim Y
• Choi SJ
• Oh SY
• Roh CR
• Kim JH

• KMID: 2420174
• DOI: http://doi.org/10.5468/ogs.2018.61.2.209

Abstract

OBJECTIVE
Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women.
METHODS
Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994-2004; period 2: 2005-2015) and place of delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used to evaluate the usefulness of APACHE II score to predict maternal mortality.
RESULTS
During 22-year period, 176 women required ICU admission, showing the incidence of 2.2 per 1,000 deliveries. The most common reason for ICU admission was postpartum hemorrhage (56.3%), followed by hypertensive disorders (19.3%), sepsis (3.4%), and pulmonary and amniotic fluid embolism (2.3%). Period 2 showed older maternal age (32.7±4.8 vs. 30.8±4.4 years, P=0.006, higher embolization rate (26.4% vs.1.2%, P < 0.001), and lower hysterectomy rate (30.8% vs. 49.4%, P=0.012). Cases from local hospitals showed significantly higher proportion of postpartum hemorrhage (84.5% vs. 42.2%, P < 0.001). Overall maternal death occurred in 5.1% (9/176) including 6 direct maternal deaths. The APACHE II score showed area under the ROC curve of 0.813 (confidence interval [CI], 0.607-1.000) for prediction of maternal mortality.
CONCLUSION
The incidence of obstetric ICU admission was 2.2 per 1,000 deliveries and the most common reason was postpartum hemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.

Keyword

Intensive care units; Maternal death; Postpartum hemorrhage; Amniotic fluid embolism; Acute physiology and chronic health evaluation (APACHE)

MeSH Terms

APACHE
Critical Care*
Embolism, Amniotic Fluid
Female
Humans
Hysterectomy
Incidence
Intensive Care Units*
Maternal Age
Maternal Death
Maternal Mortality
Mortality
Postpartum Hemorrhage
Pregnancy
Retrospective Studies
ROC Curve
Sepsis
Tertiary Care Centers*
Tertiary Healthcare*

Figure

• 

  Fig. 1 Receiver-operator characteristic curve analysis of acute physiology and chronic health evaluation (APACHE) II score to predict mortality in obstetric patients admitted to the intensive care unit. (A) All obstetric patients. The round circle indicates (B) patients with postpartum hemorrhage. AUC, area under the receiver operating characteristic curve.

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