Analysis of disease in the obstetric intensive care unit at a university referral center: a 24-month review of prospective data.

Objective: To determine the current spectrum of disease in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital.

Study Design: Analysis of data from obstetric patients admitted for critical care management at the University of Maryland Medical Center over a 24-month period.

Results: Critical care admission was required for 34 (1.3%) of 2,565 women admitted for deliveries; 38.5% of patients were delivered during their ICU admission. Preexisting medical conditions were present in 67.6% (76.5% were in the antenatal period vs. 23.5% in the postpartum period). Conditions leading to ICU admission included organ system failure, respiratory failure, central nervous system disease, cardiac failure, preeclampsia and postpartum hemorrhage. The median Acute Physiology and Chronic Health Evaluation II (APACHE II) score overall was 11.0 (antenatal 12.0, postpartum 10.5). Although the predicted maternal mortality rate was 12.9% (14.6% in the antenatal period and 12.1% in the postpartum period), the actual mortality rate was 0%.

Conclusion: In this population, the antenatal period now accounts for the majority of ICU admissions. Respiratory failure (mainly from infectious etiologies) has surpassed obstetric hemorrhage as the primary reason for ICU admission. Finally, the APACHE II scoring system is inaccurate for use in an obstetric population.