Critically unwell obstetric patients have unique physiological changes that complicate their care. Challenges presented by critically ill obstetric patients in Australia have previously been describedbut further identification of indications for Intensive Care Unit (ICU) admission and required interventions will optimise care and resource allocation.
This retrospective audit examined the epidemiology, management interventions and outcomes of obstetric critical care admissions at The Royal Brisbane and Women’s Hospital (RBWH).
Ethics exemption was obtained. Patients included delivered between October 1st 2014 and December 31st 2017, and were admitted antenatally or postnatally to the ICU. Obstetric, intervention and outcome data was extracted from ICU electronic records.
Of 7688 total ICU admissions, 86 (1.1 %) were obstetric. Of the obstetric admissions: 22 (25.6%) were admitted antenatally and 64 (74.4%) postnatally. The mean (SD) age was 30.4 (7.1) years and BMI 26.5 (9.7). During admission, 64 (74.4%) delivered: 55 (63.9%) by caesarean section birth and 9 (10.4%) vaginally. In the 24 hours prior to ICU admission; 4 (4.7 %) had cardiac arrests and 2 (2.3%) had respiratory arrests. Indications for ICU admission were: 35 (40.7%) for direct obstetric causes, 51 (60.7%) for indirect or non-obstetric causes.[2,3,4] Haemorrhage accounted for 23 (27%) of admissions, and hypertensive disorders 6 (7%). On admission to ICU, 10 (11.6%) were febrile, 4 (4.7%) were either hypotensive or hypertensive and 28 (33%) women had a GCS less than 10. In ICU, 22 (26%) required mechanical ventilation, 14 (16%) inotropic support and 15 (17%) blood products. The mean (SD) length of stay (LOS) in ICU was 2.5 (4.5) days compared to 3.26 (6.22) of total adult admissions. Maternal mortality was 3 (3.5%).
We have described a high risk tertiary referral centre obstetric population. The commonest reasons for ICU admission were indirect or non-obstetric causes. Mechanical ventilation, was the commonest organ support intervention. Obstetric ICU admissions had a shorter LOS than the general ICU population.