Pre-eclampsia in the intensive care unit: indicators of severity and hospital outcome

Introduction

Pre-eclampsia is a disease unique to pregnancy that is often associated with significant maternal morbidity and mortality, especially when it is severe. The aim of this study was to evaluate which indicators of severe pre-eclampsia were among the reasons for ICU admission and their impact on the length of hospital stay.

Materials and methods

We used a computerized database to identify 444 women with pre-eclampsia–eclampsia among 32,382 deliveries from 1996 to 2003 in our institution. Of these, 24 women were admitted to the ICU because of severe pre-eclampsia and were retrospectively included in our study. Maternal demographic data included age, parity and medical history. Gestational age, mode of delivery, days staying in the ICU and in the ward, outcome of ICU admission and SAPS II score were record for each patient. Indicators of severe pre-eclampsia on admission to the ICU included a sustained BP of 160/110 mmHg or more, proteinuria 4+ on qualitative assessment, oliguria (< 20–30 ml/hour), renal insufficiency (creatinine level >1.3 mg/dl), elevated liver enzymes, low platelet count (<100,000/μl), positive testing for hemolysis, epigastric pain, headache, visual disturbances and seizures. In the statistical analysis we used the t test on SPSS^®. Data were considered significant when P < 0.05.

Results

The mean maternal age was 29 years. Twelve women were nulliparous (50%). No women had history of chronic hypertension. All 24 women underwent a cesarian delivery because of severe pre-eclampsia at > 20 weeks of gestation, except for one woman with pregnancy of 16 weeks. All 24 women had at least one indicator of severity on admission to ICU that included BP ≥ 160/110 mmHg (n = 13), elevated liver enzymes (n = 13), low platelet count (n = 12), oliguria (n = 11), headaches (n = 8), epigastric pain (n = 7), seizures (n = 6), renal insufficiency (n = 2) and hemolysis (n = 2). The mean SAPS II score was 15. Complications occurred in eight women. None of the women died. The average length of stay was 3 days in the ICU and 10 days in the ward. Indicators of severity related to longer hospital stay were seizures (P = 0.002), epigastric pain (P = 0.004) and oliguria (P = 0.004). No significant difference was found regarding other severity indicators, SAPS II score and development of complications.

Conclusions

Our results have limited significance mainly because of the sample size (n = 24). However, they may potentially guide intensive care of these patients in order to shorten hospital stay and reduce inherent morbidity and costs. Intensivists as well as obstetricians should work closely toward this purpose.