Obstetric patients in a surgical intensive care unit: prognostic factors and outcome

Summary

The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 – 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 – 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 – 0.99]). Median length of stay was longer in non- survivors (6.5 ± 7.3 vs 5.5 ± 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.