CRITICAL CARE IN OBSTETRICAL PATIENTS - AN 8-YEAR REVIEW

Objective To review the clinical characteristics and outcomes of criti cally ill obstetrical patients and to determine the outcome predictabi lity using the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system. Methods A retrospective data collection of all obs tetrical patients (n=49) admitted for more than 24 hours to the Intens ive Care Unit at Kwong Wah Hospital from 1988 to 1995 was conducted. D emographics, obstetric data, preexistent medical problems, diagnosis, days staying in the ICU and ICU related data were recorded for each pa tient. Results Obstetric admissions to ICU during the study period rep resented 0.12% of all deliveries during this period. There was a predo minance of postpartum admissions and obstetric diagnosis responsible f or the patients' critical illness. Massive postpartum haemorrhage was the single most common cause of ICU admission, representing 53.0% of a ll patients. Preeclampsia and (14.3%), anaesthesia related complicatio ns and medical diseases complicating pregnancy (14.3%) were the other common disease categories for ICU admission. Two cases (4.1%) of surgi cal disease complicating pregnancy were admitted. The maternal mortali ty rate was 5.1 deaths per 100 000 total births, or 2 maternal deaths in 39 354 total deliveries in this study period. All deaths were due t o nonobstetric causes. The perinatal mortality rate was 10.0% (5 cases ) in this study group. Conclusions When applying the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting the final outcome in this group of obstetric patients, we found that our obstetric patients requiring intensive care had a better outcome t han predicted, as expressed by a low mortality ratio (0.25).