Eleven years of critical obstetric pathology: epidemiologic study

Introduction

The objective was to describe the characteristics of pregnant and puerperal women admitted to the ICU from February 2000 to February 2011.

Methods

Patients admitted between the mentioned periods were grouped by age, sex, nationality, APACHE II score, days in the ICU, cause of admission: hypertensive syndromes in pregnancy (HSP), preeclampsia (P), eclampsia (E), HELLP syndrome (H), gestational diabetes, sepsis and placentary disorders; need for mechanical ventilation (MV) and dialysis, maternal mortality, and if they had proper prenatal care.

Results

A total of 3,568 patients were admitted, from which 471 patients (13.2%) were of obstetric cause; average age was 24 years, APACHE II score of 6. There were 39 cases of arterial hypertension and 26 of diabetes mellitus before pregnancy. Sixty-eight percent were first pregnancy. The most frequent causes of admission were hypertension secondary to pregnancy (HSP) in 353 patients (75%): P 44% (n = 156), E 8% (n = 28), H 33% (n = 116), H/E combined 15% (n = 53). Other causes of admission: sepsis 16% (n = 75), placental disorders 7% (n = 33), and neurological deterioration (CVA/S SHEEHAN) 2% (n = 10). They required an average of two drugs to control blood pressure for the patients who needed it in 68% (n = 320). The average stay in the ICU was 6.5 days. From a total of 471 patients, 73 patients required mechanical ventilation (15%) and 118 (25%) patients presented high levels of urea and creatinine, 11 patients (2%) required dialysis. With respect to nationality 301 patients (64%) were Argentinean, the others reported were from Bolivia, Paraguay and Peru. Prenatal checks occurred in only 35% (n = 165) of the patients. The mortality rate was 6% (n = 28).

Conclusion

Critical obstetrical pathology is common in the ICU, HSP as the main cause. A high number of first pregnancy patients with little prenatal care was observed. This type of patient requires low levels of life support.