Factors affecting intensive care requirement and outcome in obstetric cases (retrospective analysis)

Aim: The aim of this study is to evaluate retrospectively the cases, who are admitted to the intensive care unit (ICU) during pregnancy or the first 42 days postpartum. Method: The files of pregnant women or patients in the first 42 days postpartum admitted to the ICU of the Anesthesiology and Reanimation Department of Istanbul Medical Faculty between January 2009 and December 2017 were examined. Demographic data, type of delivery, anesthesia method if applied, source and time of admission to the ICU, reason for admission, systemic diseases, duration of stay, death, invasive procedures and treatments applied in the ICU, and the need for blood products were recorded. Results: Data of a total of 324 patients were analyzed. The average age was 30,4 ± 5.5 years. 178 patients (54,9%) were admitted due to obstetric and 146 patients (45,1%) for nonobstetric reasons. Obstetric reasons were preeclampsia in 58 (32,6%), eclampsia in 17 (9,5%), HELLP syndrome in 45 (25,3%) and peripartum bleeding in 81 (45,5%), sepsis in 5 (2,8%) cases. The most common nonobstetric cause was cardiovascular system diseases detected in 70 patients (47,9%). The median length of stay for patients admitted for obstetric reasons was 1,32 [0.08-28] days, while for with nonobstetric reasons were 1 [0.08-13,6] days (p = 0.003). It was observed that the duration of stay of the patients with nonobstetric cause and additional systemic disease after cesarean section under general anesthesia admitted to the ICU during working hours was significantly shorter. On the other hand patients who were admitted from another hospital and who needed blood products stayed for a longer time. Mortality rate was found to be 3,08%. It was found that invasive procedures were used more frequently in patients with obstetric reasons. Conclusion: The number, duration of stay, need for blood products and mortality rate were higher in patients admitted to ICU because of obstetrical reasons compared to those with nonobstetrical causes. Peripartum bleeding took the first place among the obstetric reasons, whereas cardiovascular diseases were most common nonobstetric causes. The patiens with obstetric reasons required more invasive procedures and organ support. For theese patients longer ICU stay and more supportive treatment should be considered. Considering the short ICU stay of patients with systemic diseases, who had elective cesaren section in daytime and admitted to ICU for follow-up, it is our opinion that postoperative care unit or 1st-2nd level ICU's are needed. Consequently unnecessary occupation of limited multidisciplinary ICU beds can be avoided.