Intensive care unit admission of obstetric cases: a single centre experience with contemporary update.

Objectives: To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. Design: Retrospective case series. Setting: A regional hospital in Hong Kong. Patients: Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. Results: From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by preeclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with Intensive care unit admission of obstetric cases: a single centre experience with contemporary update Hong Kong Med J 2014;20:24–31 DOI: 10.12809/hkmj133924 Vivian KS Ng *, TK Lo, HH Tsang, WL Lau, WC Leung 1 VKS Ng *, MB, ChB, MRCOG 1 TK Lo, MB, BS, FHKAM (Obstetrics and Gynaecology) 2 HH Tsang, MRCP, FHKAM (Medicine) 1 WL Lau, MB, BS, FHKAM (Obstetrics and Gynaecology) 1 WC Leung, MD, FHKAM (Obstetrics and Gynaecology) 1 Department of Obstetrics and Gynaecology 2 Department of Intensive Care Kwong Wah Hospital, Yaumatei, Kowloon, Hong Kong * Corresponding author: vivian_nks@hotmail.com This article was published on 20 June 2013 at www.hkmj.org. ORIGINAL ARTICLE fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). Conclusion: Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance. Thus, the purpose of this study was to review and compare the characteristics of obstetric patients admitted to the ICU over the recent 20 years using historical controls, with respect to their epidemiology, medical background, antenatal and peripartum risks, durations of ICU stay, interventions in the ICU, and predictability of the Acute Physiology and Chronic Health Evaluation (APACHE II) score, as well as maternal and fetal outcomes.