Identifying the Critically Ill Parturient

Abstract

In the United States (USA), maternal mortality has increased in the last 25 years. Much of this increase is likely attributable to a higher burden of maternal medical illness [1–6]. Maternal morbidity and “near miss” events have also markedly increased during the same interval, by as much as 75% by some estimates [6]. Maternal critical illness, defined by end organ dysfunction, need for advanced treatment (need for ventilation, vasopressor requirement) or diagnostic criteria (see Chap. 1), is now relatively common in the obstetric population [7]. Admission of a pregnant or postpartum patient to the ICU is estimated to occur in 1 in every 300 deliveries [8], accounting for 12.1% of all ICU admissions for women aged 16–50 [9]. Obstetric patients requiring ICU-level care are also being treated outside of the formal critical care setting, with studies showing that 1–3% of parturients require ICU-level care or are at risk of developing maternal critical illness [10, 11]. Identifying obstetric patients at risk of clinical deterioration and critical illness, therefore, represents an important component of a comprehensive strategy to address the needs of increasingly ill pregnant and postpartum women. Early identification of those at risk may accelerate transfer to high-risk centers and/or allows timely intervention, thereby reversing these trends in morbidity and mortality.