ABSTRACT
Critically ill obstetric patients represent an interesting group with unique characteristics, whose management is challenged by the presence of a fetus, an altered maternal physiology, and diseases specific to pregnancy. To review a series of critically ill obstetric patients admitted to our medical-surgical intensive care unit [ICU] to assess the spectrum of disease, required interventions, and maternal mortality, and to identify conditions associated with maternal death. This retrospectively designed cohort study comprised 365 patients [age, 26 +/- 8 years; mean gesta-tional age, 29 +/- 9 weeks] [mean +/- SD], constituting 2.8% of 13,000 ICU admissions. APACHE II score was 13 +/- 7, with 23% predicted mortality; SOFA score was 5 +/- 3; and TISS score at 24 h was 25 +/- 9. Forty-one percent of patients required mechanical ventilation. ARDS, shock, and organ dysfunction were present in 18.6%, 27%, and 49% of patients, respectively. Most patients [63%] were admitted postpartum, and 75% of admissions were of obstetric cause. Hypertensive disease [40%], major hemorrhage [17%], septic abortion [13.7%], and non-obstetric sepsis [13.2%] were the principal diagnoses. Maternal mortality was 11.5%, with multiple organ dysfunction syndrome [43%] and intracranial hemorrhage [38%] as main causes. There were no differences in death rate in patients admitted for obstetric and non-obstetric causes. Only 32% of patients received antenatal care, which was more frequent in survivors [33% Vs 6% non-survivors, p=0.014]. Although ARDS, organ failures, shock, and use of MV were extremely frequent in this population, maternal mortality remains within an acceptable range. APACHE II overpredicted mortality in these patients. Septic abortion is still an important modifiable cause of mortality. Efforts should concentrate in increasing antenatal care, which was clearly underprovided in these patients