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. 2022 Feb 21;22(1):140.
doi: 10.1186/s12884-022-04480-x.

Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit

Ning Gu  1 , Yaning Zheng  1 , Yimin Dai  2
Affiliations

Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit

Ning Gu et al. BMC Pregnancy Childbirth. .

Abstract

Background: To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU).

Methods: This is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU in a provincial referral center in China from January 2014 to December 2019. The collected information included maternal demographic characteristics, indications for ICU and HDU admission, the length of ICU stay, the total length of in-hospital stay and APACHE II score. Chi-square and ANOVA tests were used to determine statistical significance. The temporal changes were assessed with chi-square test for linear trend.

Results: A total of 40,412 women delivered and 447 (1.11%) women were admitted to ICU in this 6-year period. The rate of ICU admission peaked at 1.59% in 2016 and then dropped to 0.67% in 2019 with the introduction of obstetric HDU. The average APACHE II score increased significantly from 6.8 to 12.3 (P < 0.001) and the average length of ICU stay increased from 1.7 to 7.1 days (P < 0.001). The main indications for maternal ICU admissions were hypertensive disorders in pregnancy (39.8%), cardiac diseases (24.8%), and other medical disorders (21.5%); while the most common reasons for referring to HDU were hypertensive disorders of pregnancy (46.5%) and obstetric hemorrhage (43.0%). The establishment of HDU led to 20% reduction in ICU admission, which was mainly related to obstetric indications.

Conclusions: The introduction of HDU helps to reduce ICU utilization in obstetric population.

Keywords: High dependency unit; Hypertensive disorders in pregnancy; Intensive care unit; Pre-existing medical disease; Severe maternal morbidity.

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Conflict of interest statement

The authors have no conflicts of interest.

References

    1. Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 211: Critical Care in Pregnancy. Obstet Gynecol. 2019;133:e303–19. - PubMed
    1. Liu J, Song L, Qiu J, Jing W, Wang L, Dai Y, et al. Reducing maternal mortality in China in the era of the two-child policy. BMJ Glob Health. 2020;5(2):e002157. doi: 10.1136/bmjgh-2019-002157. - DOI - PMC - PubMed
    1. Zhao Z, Han S, Yao G, Li S, Li W, Zhao Y, et al. Pregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report. Crit Care Med. 2018;46(10):e1002–e1009. doi: 10.1097/CCM.0000000000003355. - DOI - PMC - PubMed
    1. Ryan M, Hamilton V, Bowen M, McKenna P. The role of a high-dependency unit in a regional obstetric hospital. Anaesthesia. 2000;55:1155–1158. doi: 10.1046/j.1365-2044.2000.01627.x. - DOI - PubMed
    1. Liu Y, Tan G, Cheng S, Sun X. The ICU Is Becoming a Main Battlefield for Severe Maternal Rescue in China: An 8-Year Single-Center Clinical Experience. Crit Care Med. 2017;45:e1106–e1110. doi: 10.1097/CCM.0000000000002673. - DOI - PMC - PubMed