CRITICAL CARE MANAGEMENT OF THE OBSTETRIC PATIENT

Purpose: To review a series of critically ill obstetric patients admit ted to a general intensive care unit in a Canadian centre, to assess t he spectrum of diseases, interventions required and outcome. Methods: A retrospective chart review was performed of obstetric patients admit ted to the intensive: care unit of an academic hospital with a high-ri sk obstetric service, during a five-year period. Data obtained include d the admission diagnosis, ICU course and outcome. Daily APACHE II and TISS scores were recorded. Results: Sixty-five obstetric patients, re presenting 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 non-obstetric (29%) complicati ons. The mean APACHE II score was 6.8 +/- 4.2 and mean TISS score was 24 +/- 8.1. Twenty-seven patients (42%) required mechanical ventilatio n. No maternal mortality occurred and the perinatal mortality rate was 11%. Conclusions: A small proportion of obstetric patients develop co mplications requiring ICU admission. The outcome in this study was exc ellent, in contrast to that reported in other published studies with s imilar ICU admission rates. The universal availability of prenatal car e 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 pre gnant patient makes comparison of case series difficult.