Pregnant and postpartum admissions to the intensive care unit: a systematic review
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To determine the incidence and characteristics of pregnant and postpartum women requiring admission to an intensive care unit (ICU).
Medline, PubMed, EMBASE and CINAHL databases (1990–2008) were systematically searched for reports of women admitted to the ICU either pregnant or up to 6 weeks postpartum. Two reviewers independently determined study eligibility and abstracted data.
A total of 40 eligible studies reporting outcomes for 7,887 women were analysed. All studies were retrospective with the majority reporting data from a single centre. The incidence of ICU admission ranged from 0.7 to 13.5 per 1,000 deliveries. Pregnant or postpartum women accounted for 0.4–16.0% of ICU admissions in study centres. Hypertensive disorders of pregnancy were the most prevalent indication for ICU admission [median 0.9 cases per 1,000 deliveries (range 0.2–6.7)]. There was no difference in the profile of ICU admission in developing compared to developed countries, except for the significantly higher maternal mortality rate in developing countries (median 3.3 vs. 14.0%, p = 0.002). Studies reporting patient outcomes subsequent to ICU admission are lacking.
ICU admission of pregnant and postpartum women occurs infrequently, with obstetric conditions responsible for the majority of ICU admissions. The ICU admission profile of women was similar in developed and developing countries; however, the maternal mortality rate remains higher for ICUs in developing countries, supporting the need for ongoing service delivery improvements. More studies are required to determine the impact of ICU admission for pregnant and postpartum women.
KeywordsCritical care Intensive care Severe maternal morbidity Severe obstetric morbidity Near miss
Conflict of interest statement
The authors have no potentially conflicting financial interests or any other actual or potential conflict of interest to be declared.
- 1.Public Health Agency of Canada (2005) Make every mother and child count: report on maternal and child health in Canada. Make every mother and child count: report on maternal and child health in Canada. http://www.phac-aspc.gc.ca/rhs-ssg/pdf/whd_05epi_e.pdf. Accessed 1 Sept 2009
- 2.Mantel G, Buchmann E, Rees H, Pattinson RC (1998) Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Br J Obstet Gynaecol 105:985–990Google Scholar
- 5.Say L, Pattinson RC, Gulmezoglu AM (2004) WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health 1(3). doi: 10.1186/1742-4755-1-3
- 9.Zhang WH, Alexander S, Bouvier-Colle MH, Macfarlane A (2005) Incidence of severe pre-eclampsia, postpartum haemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population-based study: the MOMS-B survey. Int J Obstet Gynaecol 112:89–96Google Scholar
- 11.Higgins, Green (eds) (2008) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration. Wiley, ChicesterGoogle Scholar
- 12.United Nations Population Division (2007) World population prospects: the 2006 Revision population database. Book World population prospects: the 2006 Revision population database. United Nations. http://unstats.un.org/unsd/cdb/cdb_dict_xrxx.asp?def_code=491. Accessed 1 Sept 2009
- 22.Platteau P, Engelhart T, Moodley J, Muckart DJJ (1997) Obstetric and gynaecological patients in an intensive care unit: a 1 year review. Trop Doctor 27:202–206Google Scholar
- 39.Munnur U, Karnad DR, Bandi VDP, Lapsia V, Suresh MS, Ramshesh P, Gardner MA, Longmire S, Guntupalli KK (2005) Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes. Intensive Care Med 31:1087–1094CrossRefPubMedGoogle Scholar
- 42.Rajab K, Skerman J (2005) Obstetric conditions requiring intensive care admission: a 5 year survey. Middle East J Emerg Med 5 (1). http://www.hmc.org.qa/mejem/march2005/Edited/os2.htm
- 46.Tempe A, Wadhwa L, Gupta S, Bansal S, Satyanarayana L (2007) Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions. Ind J Med Sci 62:179–185Google Scholar
- 48.Sriram S, Robertson M (2008) Critically ill obstetric patients in Australia: a retrospective audit of 8 years’ experience in a tertiary intensive care unit. Crit Care Resusc 10:120–124Google Scholar
- 51.Hariharan S, Chen D, Merritt-Charles L, Bobb N, De Freitas L, Esdelle-Thomas A, Mohammed J, Charles D, Colley K, Renaud E (2006) An evaluation of the intensive care unit resources and utilization in Trinidad. West Indies Med J 56:144–151Google Scholar
- 53.Lewis G (2007) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003–2005. The seventh report on confidential enquiries into maternal deaths in the united kingdom. Book Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003–2005. The seventh report on confidential enquiries into maternal deaths in the united kingdom. http://www.cmace.org.uk/getattachment/7654804a-9442-4a30-8857-4c2ec4391ae3/Saving-Mothers%E2%80%99-Lives-2003-2005_MidwifSumm.aspx. Accessed 1 Sept 2009
- 54.Lakshmi R, Upreti D, Agrawal A, Raina A (2007) Late postpartum eclampsia at 5 weeks post-delivery. Singap Med J 48(10):946–947Google Scholar
- 57.Laws P, Sullivan EA (2009) Australia’s mothers and babies 2007. Perinatal statistics series no. 23. Cat no PER 48. AIHW National Perinatal Statistics Unit, SydneyGoogle Scholar