Multicenter study of obstetric admissions to 14 intensive care units in southern England

Objectives: To identify pregnant and postpartum patients admitted to intens ive care units (ICUs), the cause for their admission, and the proportion th at might be appropriately managed in a high-dependency environment (HDU) by using an existing database. To estimate the goodness-of-fit for the Simpli fied Acute Physiology Score II, the Acute Physiology and Chronic Health Eva luation (APACHE) II, and the APACHE III scoring systems in the obstetrical population. Design: Retrospective analysis of demographic, diagnostic, treatment, and s everity of illness data. Setting: Fourteen ICUs in Southern England. Patients: Pregnant or postpartum (<42 days) admissions between January 1, 1 994, and December 31, 1996. Interventions: None. Measurements and Main Results:We identified 210 patients, constituting 1.84 % (210 of 11,385) of all ICD admissions and 0.17% (210 of 122,850) of all d eliveries. Most admissions followed postpartum complications (hypertensive disease of pregnancy [39.5%] and major hemorrhage [33.3%]). Seven women wer e transferred to specialist ICUs. There was considerable variation between ICUs with respect to the number and type of interventions required by patie nts. Some 35.7% of patients stayed in ICU for <2 days and received no speci fic ICU interventions; these patients might have been safely managed in an HDU. There were seven maternal deaths (3.3%); fetal mortality rate was 20%. The area under the receiver operator characteristic curve and the standard ized mortality ratio were 0.92 (confidence interval [CI], 0.85-0.99) and 0. 43 for the Simplified Acute Physiology Score II, 0.94 (CI, 0.86-1.0) and 0. 24 for APACHE II, and 0.98 (CI, 0.96-1.0) and 0.43 for APACHE III, respecti vely. Conclusions: Existing databases can both identify critically ill obstetrica l patients and provide important information about them. Obstetrical ICU ad missions often require minimal intervention and are associated with low mor tality rates. Many might be more appropriately managed in an HDU. The commo nly used severity of illness scoring systems are good discriminators of out come from intensive care admission in this group but may overestimate morta lity rates. Severity of illness scoring systems may require modification in obstetrical patients to adjust for the normal physiologic responses to pre gnancy.