Risk factors for maternal condition at admission to an intensive care unit: Does health care organisation play a role?

The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991 . The population study included 355 patients who were admitted to an ICU du ring pregnancy, delivery or within 42 days after delivery, for an obstetric al cause. The main outcome measure was the severity of maternal condition a t ICU admission estimated from the level of consciousness and from the Simp lified Acute Physiology Score (SAPS). The most severe maternal condition wa s associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and wi th treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3) . Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation du ring pregnancy affects the prognosis of severe maternal condition. The fact ors invoked appear to include the management of unpredictable disorders, th e conditions of maternal transfers before ICU admission, and antenatal care of foreigners.