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Canadian Journal of Anaesthesia

, Volume 44, Issue 3, pp 325–329 | Cite as

Critical care management of the obstetric patient

  • Stephen E. Lapinsky
  • Kristine Kruczynski
  • Gareth R. Seaward
  • Dan Farine
  • Ronald F. Grossman
Occasional Review

Abstract

Purpose

To review a series of critically ill obstetric patients admitted to a general intensive care unit in a Canadian centre, to assess the spectrum of diseases, interventions required and outcome.

Methods

A retrospective chart review was performed of obstetric patients admitted to the intensive care unit of an academic hospital with a high-risk obstetric service, dunng a five-year penod. Data obtained included the admission diagnosis. ICU course and outcome. Daily APACHE II and TISS scores were recorded.

Results

Sixty-five obstetric patients, representing 0.26% of deliveries in this hospital, were admitted to the ICU during the study period. All had received prenatal care. Admission diagnoses included obstetric (71%) and nonobstetric (29%) complications. The mean APACHE II score was 6.8 ± 4.2 and mean TISS score was 24 ± 8.1. Twenty-seven patients (42%) required mechanical ventilation. No maternal mortality occurred and the perinatal mortality rate was 11 %.

Conclusions

A small proportion of obstetric patients develop complications requiring ICU admission. The out-come in this study was excellent, in contrast to that reported in other published studies with similar ICU admission rates. The universal availability of prenatal care may be an important factor in the outcome of this group of patients. The lack of a specific severity of illness scoring system for the pregnant patient makes comparison of case series difficult.

Keywords

Prenatal Care Maternal Mortality Spinal Muscular Atrophy Thrombotic Thrombocytopenic Purpura Obstetric Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectifs

Revoir les dossiers d’une groupe de parturientes sérieusement malades admises à l’unité des soins intensifs (USI) généraux d’un centre hospitalier canadien, évaluer l’éventail des affections, les interventions nécessaires et les résultats obtenus.

Méthodes

Revue rétrospective de dossiers de parturientes admises à l’USI d’un hôpital universitaire canadien doté d’un service d’obstétrique pour patientes à risques élevés pendant une période de cinq ans. Les données obtenues comprenaient le diagnostic à l’admission, l’évolution à l’USI et les résultats. Les scores APACHE Il et TISS étaient enregistrés quotidiennement.

Résultats

Soixante-cinq parturientes représentant 0,26% des accouchements de l’hôpital ont été admises à l’USI pendant la période étudiée. Toutes avaient bénéficié des soins prénataux. Les patientes étaient admises pour des complications obstétncales (71%) ou autres (29%). Les scores APACHE et TilSS moyens étaient respectivement 6.8 ± 4.2 et 24 ± 8.1. Vingt–sept patientes (42%) ont été ventilées mécaniquement. Il n’y a pas eu de mortalité maternelle et le taux de mortalité périnatale était de 11 %.

Conclusions

Une faible proportion des partunentes développent des complications nécessitant des soins intensifs. Pour cette étude, les résultats sont excellents, contrairement à d’autres publiés ailleurs comportant des taux d’admission aux soins intensifs identiques. L’universalité de l’accès aux soins prénataux pourrait influencer considérablement les résultats dans ce groupe de patientes. L’absence d’un système de score spécifique à la gravité des affections de la grossesse rend la comparaison entre séries difficile.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Stephen E. Lapinsky
    • 1
  • Kristine Kruczynski
    • 1
  • Gareth R. Seaward
    • 2
  • Dan Farine
    • 2
  • Ronald F. Grossman
    • 1
  1. 1.Intensive Care Unit, Department of MedicineMount Sinai HospitalTorontoCanada
  2. 2.Division of Maternal/Feral MedicineMount Sinai HospitalToronto

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