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Critically ill severe pre-eclamptic patients admitted to an obstetric intensive care unit

Objective

To profile severe pre-eclamptic (SPE) patients admitted to an obstetric ICU, with regards to manifestations, interventions and clinical outcome.

Methods

Medical records of all SPE patients admitted from 2002 to 2004 to our ICU were retrospectively analysed.

Results

One hundred and four patients with SPE were admitted, 89% postpartum. This represents 38.5% of all obstetric admissions to the ICU, and 0.23% of all deliveries in our hospital, during the same period.

All except five patients (4.8%) received antenatal care, of which 40.4% were known pre-eclamptics on medication. The mean gestational age at detection of SPE was 32.5 (0.4) weeks, with a mean arterial pressure of 129.2 (1.7) mmHg.

Reasons for ICU admission in addition to SPE included pulmonary edema (14.4%), oliguria (14.4%), hemolysis elevated liver enzymes low platelet (HELLP) syndrome (18.3%), eclampsia (7.7%), and intracerebral hemorrhage (1%). The incidence of eclampsia was 1.7 per 10,000 births.

Arterial lines were inserted in 64.4% and central venous catheters in 18% of patients. Magnesium sulphate therapy was instituted in 69.2% of patients for a mean duration of 28.7 (2.6) hours. Forty-seven percent of patients received intravenous and oral antihypertensives, while 45% required oral antihypertensives only. Nine patients (8.6%) received invasive mechanical ventilation for 29.6 (13.4) hours, and three patients (2.9%) required renal replacement therapy.

The mean ICU length of stay was 46.5 (2.0) hours. Indications for delivery in addition to SPE were worsening maternal biochemical indices (42.3%), fetal distress (18.3%), pulmonary edema (11.5%), impending eclampsia (16.3%), and eclampsia (3.8%). Delivery was by emergency Caesarean section in 90.4%, and vaginal delivery in 9.6%. Mean gestational age at delivery was 33.2 (0.4) weeks, with birthweight 1894 (81) g, and mean Apgar score of 7 at 1 min, and 8 at 5 min. A total 14.4% of babies were small for gestational age, and four perinatal mortalities occurred (0.09 per 1000 births). There were only two maternal deaths (0.04 per 1000 deliveries).

Conclusion

SPE is a prevalent cause of maternal–fetal morbidity. With improved obstetric and intensive care, the current incidence of eclampsia (1.7 per 10,000 births) is one of the lowest in published literature for a tertiary referral maternity hospital.

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Teoh, W., Neo, H. & Tan, I. Critically ill severe pre-eclamptic patients admitted to an obstetric intensive care unit. Crit Care 9, P214 (2005). https://doi.org/10.1186/cc3277

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Keywords

  • Renal Replacement Therapy
  • Pulmonary Edema
  • Eclampsia
  • Magnesium Sulphate
  • Emergency Caesarean Section