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Obstetric admission to intensive care units in Japan: a cohort study using the Japanese Intensive care PAtient Database

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Abstract

Purpose

This study aimed to describe the epidemiology and annual trends of obstetric patients using a multicenter intensive care database.

Methods

This multicenter, retrospective cohort study used the Japanese Intensive care PAtient Database (JIPAD). We included obstetric patients registered in the JIPAD between 2015 and 2020. We investigated the proportion of obstetric patients among all patients in the intensive care unit (ICU). We also described the characteristics, procedures, and outcomes of obstetric patients. In addition, the annual trends were examined by nonparametric tests for trends.

Results

Of the 184,705 patients enrolled in the JIPAD, 750 (0.41%) were obstetric patients from 61 facilities. The median age was 34 years, the number of post-emergency surgeries was 450 (60.0%), and the median APACHE III score was 36. Mechanical ventilation was the most common procedure performed in 247 (32.9%) patients. There were five (0.7%) in-hospital deaths. The proportion of obstetric patients in the ICU did not change between 2015 and 2020 (P for trend = 0.32). However, there was a trend for a significant decrease in the severity of illness and length of hospital stay on an annual basis between 2015 and 2020. Most patients were admitted to the ICU because of a pregnancy-related disorder postoperatively.

Conclusion

The proportion of obstetric patients was 0.41% of all ICU admissions. The proportion of obstetric patients admitted to the ICU did not change from 2015 to 2020, but the patients’ severity of illness and length of hospital stay significantly decreased over time.

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Data availability

The datasets generated and analyzed in the present study are managed by the JIPAD working group. They can be obtained from the corresponding author upon a reasonable request, but acquiring them typically necessitates permission from the JIPAD working group.

References

  1. Trends in maternal mortality: 2000 to 2017 [Internet]. [cited 2022 Jul 3]. Available from: https://www.unfpa.org/featured-publication/trends-maternal-mortality-2000-2017

  2. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118:1–203. https://doi.org/10.1111/j.1471-0528.2010.02847.x.

    Article  PubMed  Google Scholar 

  3. Attali E, Yogev Y. The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2021;70:2–9.

    Article  PubMed  Google Scholar 

  4. Paredes C, Hsu RC, Tong A, Johnson JR. Obesity and Pregnancy. Neoreviews. 2021;22:e78-87.

    Article  PubMed  Google Scholar 

  5. Leffert LR, Clancy CR, Bateman BT, Bryant AS, Kuklina EV. Hypertensive disorders and pregnancy-related stroke: frequency, trends, risk factors, and outcomes. Obstet Gynecol. 2015;125:124–31.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Faulkes RE, Chauhan A, Knox E, Johnston T, Thompson F, Ferguson J. Review article: chronic liver disease and pregnancy. Aliment Pharmacol Ther. 2020;52:420–9.

    Article  PubMed  Google Scholar 

  7. Koratala A, Bhattacharya D, Kazory A. Chronic kidney disease in pregnancy. South Med J. 2017;110:578–85.

    Article  PubMed  Google Scholar 

  8. Sunderam S, Kissin DM, Crawford S, Anderson JE, Folger SG, Jamieson DJ, Barfield WD. Assisted reproductive technology surveillance – United States. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. CDC. MMWR Surveill Summ. 2010;2013(62):1–24.

    Google Scholar 

  9. Morlando M, Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies. Int J Womens Health. 2020;12:1033–45.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Maiden MJ, Finnis ME, Duke GJ, Huning EY, Crozier TM, Nguyen N, Biradar V, McArthur C, Pilcher D. Obstetric admissions to intensive care units in Australia and New Zealand: a registry‐based cohort study. BJOG 127(12):1558–67. https://doi.org/10.1111/1471-0528.16285.

    Article  CAS  PubMed  Google Scholar 

  11. ICNARC – obstetrics [Internet]. [cited 2022 Jul 3]. Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Our-National-Analyses/Obstetrics

  12. Pollock W, Rose L, Dennis C-L. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med. 2010;36:1465–74.

    Article  PubMed  Google Scholar 

  13. Chantry AA, Deneux-Tharaux C, Bonnet M-P, Bouvier-Colle M-H. Pregnancy-related ICU admissions in France: trends in rate and severity, 2006–2009*. Crit Care Med. 2015;43:78–86.

    Article  PubMed  Google Scholar 

  14. Zwart JJ, Dupuis JRO, Richters A, Ory F, van Roosmalen J. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Intensive Care Med. 2010;36:256–63.

    Article  PubMed  Google Scholar 

  15. Aoyama K, Pinto R, Ray JG, Hill AD, Scales DC, Lapinsky SE, Hladunewich M, Seaward GR, Fowler RA. Variability in intensive care unit admission among pregnant and postpartum women in Canada: a nationwide population-based observational study. Crit Care. 2019;23:381. https://doi.org/10.1186/s13054-019-2660-x.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zhao Z, Han S, Yao G, Li S, Li W, Zhao Y, Qiao J, Zhang J, Lu J, Tao L, Han Y. Pregnancy-related ICU admissions from 2008 to 2016 in China: a first multicenter report. Crit Care Med; 2018;46(10):e1002–e1009. https://doi.org/10.1097/CCM.0000000000003355.

    Article  PubMed  PubMed Central  Google Scholar 

  17. [Internet]. [cited 2022 Jul 3]. Available from: https://www.e-stat.go.jp/dbview?sid=0003411600

  18. OECD Health Statistics 2021 - OECD [Internet]. [cited 2022 Jul 3]. Available from: https://www.oecd.org/els/health-systems/health-data.htm

  19. Irie H, Okamoto H, Uchino S, Endo H, Uchida M, Kawasaki T, Kumasawa J, Tagami T, Shigemitsu H, Hashiba E, Aoki Y, Kurosawa H, Hatakeyama J, Ichihara N, Hashimoto S, Nishimura M. JIPAD Working Group in the Japanese Society of Intensive Care Medicine. The Japanese Intensive care PAtient Database (JIPAD): a national intensive care unit registry in Japan. J Crit Care. 2020;55:86–94. https://doi.org/10.1016/j.jcrc.2019.09.004.

  20. Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of obstetric-related ICU admissions in Maryland: 1999–2008*. Crit Care Med. 2013;41:1844–52.

    Article  PubMed  PubMed Central  Google Scholar 

  21. WHO-RHR-19.23-eng.pdf [Internet]. [cited 2022 Jul 5]. Available from: https://apps.who.int/iris/bitstream/handle/10665/327596/WHO-RHR-19.23-eng.pdf?sequence=13&isAllowed=y

  22. 15_all.pdf [Internet]. [cited 2022 Dec 29]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei21/dl/15_all.pdf

  23. Botai_2021.pdf [Internet]. [cited 2022 Dec 28]. Available from: https://www.jaog.or.jp/wp/wp-content/uploads/2022/06/botai_2021.pdf

  24. [Internet]. [cited 2022 Dec 29]. Available from: https://www.j-cimels.jp/

  25. Hasegawa J, Katsuragi S, Tanaka H, Kurasaki A, Nakamura M, Murakoshi T, Nakata M, Kanayama N, Sekizawa A, Isamu I, Kinoshita K. Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep. 2019;9(1):11026. https://doi.org/10.1038/s41598-019-47378-z.

    Article  Google Scholar 

  26. Matsuzaki S, Ueda Y, Nagase Y, Matsuzaki S, Kakuda M, Kakuda S, Sakaguchi H, Hisa T, Kamiura S. Placenta accreta spectrum disorder complicated with endometriosis: Systematic review and meta-analysis. Biomedicines. 2022;10(2):390. https://doi.org/10.3390/biomedicines10020390.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, Joseph KS, Lewis G, Liston RM, Roberts CL, Oats J. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the international postpartum hemorrhage collaborative Group. BMC Pregnancy Childbirth. 2009;9:55. https://doi.org/10.1186/1471-2393-9-55.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kuriya A, Piedimonte S, Spence AR, Czuzoj-Shulman N, Kezouh A, Abenhaim HA. Incidence and causes of maternal mortality in the USA. J Obstet Gynaecol Res. 2016;42:661–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Ellen Knapp, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Hitomi Asaba, Yoshitaka Aoki, Chieko Akinaga, Satoshi Naruse, Sakiko Uchizaki, Matsuyuki Doi & Yoshiki Nakajima

  2. Foundation for Ambulance Service Development, Emergency Life-Saving Technique Academy of Tokyo, Tokyo, Japan

    Mikio Nakajima

  3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Mikio Nakajima

  4. Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan

    Hiroaki Itoh

Authors
  1. Hitomi Asaba
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  2. Yoshitaka Aoki
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  9. Yoshiki Nakajima
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Contributions

HA, YA, and CA substantially contributed to the study design. HA, YA, and MN performed the statistical analyses. HA and YA wrote the manuscript, and CA, SN, SU, MN, MD, HI, and YN were responsible for revising the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Yoshitaka Aoki.

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The authors declare that they have no conflict of interest.

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Supplementary Information

Below is the link to the electronic supplementary material.

540_2023_3200_MOESM1_ESM.pdf

Online Resource 1. Number of obstetric patients per facility stratified by the fiscal year of admission. Lines in the box represent median values and box edges represent 25th to 75th percentiles. Supplementary file1 (PDF 93 KB)

540_2023_3200_MOESM2_ESM.docx

Online Resource 2. Diagnostic categories of obstetric patients admitted to the intensive care unit. Supplementary file2 (DOCX 22 KB)

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Asaba, H., Aoki, Y., Akinaga, C. et al. Obstetric admission to intensive care units in Japan: a cohort study using the Japanese Intensive care PAtient Database. J Anesth 37, 539–545 (2023). https://doi.org/10.1007/s00540-023-03200-9

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  • DOI: https://doi.org/10.1007/s00540-023-03200-9

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