Hypertensive disease of pregnancy in the ICU: a multicenter study

Abstract

Objective: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina.

Methods: Case-series multicenter study.

Results: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6–14]; SOFA₂₄ 2[1–4]; ICU-LOS 3[2–6] days and hospital-LOS 8[5–12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) – 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02–1.13], gestational age (OR 1.14 [1.04–1.24]) and nulliparity (OR 2.40 [1.19–4.85]).

Conclusions: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.

• Critical care
• eclampsia
• HELLP
• hypertensive disease of pregnancy
• intracranial hemorrhage
• preeclampsia

Acknowledgements

We are profoundly indebted to Maria-Teresa Pérez who co-edited this manuscript and did an outstanding job revising the English in this paper, and to Jeanette Savero who assisted us with the administrative elements.

Declaration of interest

The authors report no declarations of interest