Critically ill obstetric patients in Australia: a retrospective audit of 8 years' experience in a tertiary intensive care unit

Abstract

Objective: To review the indications for admission, demographics, clinically relevant aspects of medical care and outcomes of critically ill obstetric patients admitted to a tertiary hospital intensive care unit.

Design: Retrospective review.

Setting and participants: General medical and surgical ICU of a tertiary university-affiliated hospital in central Melbourne, Victoria, Australia. Medical records were reviewed for all women who were admitted to the ICU between January 1998 and June 2006 and were pregnant or within the 6-week postpartum period. All were transferred from other hospitals.

Main outcome measures: Primary diagnoses, clinical indications for ICU admission, ICU interventions, and maternal and fetal outcomes.

Results: Over the 102-month period, 56 obstetric patients were admitted to the ICU (0.38% of all ICU admissions). Their mean (+/-SD) age was 31.8 (+/-5.76) years. All but two admissions were postpartum. The most common indications for ICU admission were haemodynamic instability (38%), respiratory complications (29%) and neurological complications (27%). Mechanical ventilatory support was required by 61% (34/56) of the patients, and blood transfusion by 48%. The median length of ICU stay was 45.75 hours (range, 8-281 hours). There were no maternal deaths, but residual functional or physical disability was noted in eight patients. There were four perinatal deaths.

Conclusions: This audit is a reminder that continued vigilance is required to ensure maternal safety. It also emphasises the need to integrate free-standing maternity units with hospital intensive care services.