Highlights
- •Obstetric ICU Admission is often a proxy for maternal near miss/severe morbidity.
- •This study analysed obstetric critical care (CC) provided in Ireland 2014–16.
- •The most common reasons for CC provision was hypertension and haemorrhage.
- •Large variability exists in rates of CC and its estimates national and internationally.
- •This is most likely due to different care settings, practices and definitions.
Abstract
Introduction
Material and methods
Results
Conclusions
Keywords
Abbreviations:
BCVS (Basic Cardiovascular Support), BMI (Body Mass Index), CC (Critical Care), CCU (Cardiac care unit), HDU (High Dependency Unit), ICU (Intensive Care Unit), IMEWS (Irish Maternity Early Warning System), IQR (Interquartile Range), MNM (Maternal Near Miss), NICU (Neonatal Intensive Care), NPEC (National Perinatal Epidemiology Centre), RoI (Republic of Ireland), SCBU (Special Care Baby Unit), SMM (Severe Maternal Morbidity)Purchase one-time access:
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Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyReferences
- Confirmed severe maternal morbidity is associated with high rate of preterm delivery.Am J Obstet Gynecol. 2016; 215: 233.e1-7https://doi.org/10.1016/j.ajog.2016.02.026
- Standardized severe maternal morbidity review: rationale and process.Obstet Gynecol. 2014; 124: 361-366https://doi.org/10.1097/AOG.0000000000000397
- Frequency of and factors associated with severe maternal morbidity.Obstet Gynecol. 2014; 123: 804-810https://doi.org/10.1097/AOG.0000000000000173
- Severe maternal morbidity and breastfeeding outcomes in the early post-natal period: a prospective cohort study from one English maternity unit.Matern Child Nutr. 2016; 12: 808-825https://doi.org/10.1111/mcn.12176
- Provision of critical care services for the obstetric population.Best Pract Res Clin Obstet Gynaecol. 2013; 27: 803-809https://doi.org/10.1016/j.bpobgyn.2013.07.005
Leitao S, Manning E, Corcoran P, San Lazaro Campillo I, Greene R, on behalf of the Severe Maternal Morbidity Group. Severe Maternal Morbidity in Ireland Annual Report 2019. National Perinatal Epidemiology Centre; 2021.
- Outcomes and trends of peripartum maternal admission to the intensive care unit.Wien Klin Wochenschr. 2017; 129: 605-611https://doi.org/10.1007/s00508-016-1161-z
- Epidemiology of obstetric critical illness.Int J Obstet Anesth. 2019; 40: 128-139https://doi.org/10.1016/j.ijoa.2019.05.010
- Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study.Intensive Care Med. 2010; 36: 256-263https://doi.org/10.1007/s00134-009-1707-x
- Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001–2010.J Clin Med Res. 2017; 9: 143-153https://doi.org/10.14740/jocmr2854w
- Characteristics of obstetric patients referred to intensive care in an Australian tertiary hospital.Aust N Z J Obstet Gynaecol. 2014; 54: 445-449https://doi.org/10.1111/ajo.12211
- Critical care in pregnancy–is it different?.Semin Perinatol. 2014; 38: 329-340https://doi.org/10.1053/j.semperi.2014.07.002
Obstetric & Gynaecology, Anaesthetic and Critical Programmes, Clinical Strategy & Programmes Division, Health Service Executive. Guidelines for the Critically Ill Woman in Obstetrics. Feidhmeannacht na Seirbhíse Sláinte/Health Service Executive; 2014. Accessed August 26, 2021. https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/guidelines-for-the-critically-ill-woman-in-obstetrics.pdf.
Health Service Executive. Towards Excellence in Critical Care: Review of Adult Critical Care Services in the Republic of Ireland.; 2009. https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/towards-excellence-in-critical-care-report.pdf.
Intensive Care Society. Levels of Adult Critical Care Second Edition.; 2021. Accessed December 8, 2021. https://www.ics.ac.uk/Society/Policy_and_Communications/Patients_and_Relatives/Levels_of_Care/Society/Patients_and_Relatives/Levels_of_Care.aspx?hkey=2a40dba7-a0b8-4669-ac85-cfa224275ca3.
Leitao S, Manning E, Greene RA, Corcoran P, Maternal Morbidity Advisory Group. Maternal morbidity and mortality: an iceberg phenomenon. BJOG Int J Obstet Gynaecol Published online August 28, 2021. doi:10.1111/1471-0528.16880.
O’Hare M, Manning E, Corcoran P, Greene RA. Confidential Maternal Death Enquiry in Ireland, Report for 2016-2018. MDE Ireland; 2020.
An Phríomh-Oifig Staidrimh/Central Statistics Office. Births 2014. Vital Statistics Annual Report 2014. Accessed August 27, 2021. https://www.cso.ie/en/releasesandpublications/ep/p-vsar/vsar2014/births2014/.
An Phríomh-Oifig Staidrimh/Central Statistics Office. Births 2015. Vital Statistics Annual Report 2015. Accessed August 27, 2021. https://www.cso.ie/en/releasesandpublications/ep/p-vsar/vitalstatisticsannualreport2015/births2015/.
An Phríomh-Oifig Staidrimh/Central Statistics Office. Births 2016. Vital Statistics Annual Report 2016. Accessed August 27, 2021. https://www.cso.ie/en/releasesandpublications/ep/p-vsar/vitalstatisticsannualreport2016/births2016/.
National Clinical Effectiveness Committee, National Patient Safety Office. Irish Maternity Early Warning System (IMEWS) V2. An Roinn Sláinte (Department of Health, Republic of Ireland); 2019. Accessed October 25, 20. https://rcpi-live-cdn.s3.amazonaws.com/wp-content/uploads/2019/03/Irish-Maternity-Early-Warning-System-IMEWS-Feb-2019.pdf.
- Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database.Crit Care. 2005; 9: S25https://doi.org/10.1186/cc3542
Intensive Care National Audit & Research Centre. Female Admissions (Aged 16-50 Years) to Adult, General Critical Care Units in England, Wales, and Northern Ireland Reported as “currently Pregnant” or “Recently Pregnant.”; 2013. https://www.oaa-anaes.ac.uk/assets/_managed/cms/files/Obstetric%20admissions%20to%20critical%20care%202009-2012%20-%20FINAL.pdf.
- Pregnancy-related ICU admissions in France: trends in rate and severity, 2006–2009.Crit Care Med. 2015; 43: 78-86https://doi.org/10.1097/CCM.0000000000000601
- Epidemiology of obstetric-related ICU admissions in Maryland: 1999–2008.Crit Care Med. 2013; 41: 1844-1852https://doi.org/10.1097/CCM.0b013e31828a3e24
- Intensive care utilization during hospital admission for delivery: prevalence, risk factors, and outcomes in a statewide population.Anesthesiology. 2000; 92: 1537-1544https://doi.org/10.1097/00000542-200006000-00009
- Review of contributory factors in maternity admissions to intensive care at a New Zealand tertiary hospital.Am J Obstet Gynecol. 2013; 209: 549-e1-7https://doi.org/10.1016/j.ajog.2013.07.031
- Maternal and neonatal characteristics in obstetric intensive care unit admissions.Int J Obstet Anesth. 2020; 41: 65-70https://doi.org/10.1016/j.ijoa.2019.07.002
- Obstetric admissions to an integrated general intensive care unit in a quaternary maternity facility.Aust N Z J Obstet Gynaecol. 2011; 51: 233-238https://doi.org/10.1111/j.1479-828X.2011.01303.x
- Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital.Gynecol Obstet Invest. 2016; 81: 315-320https://doi.org/10.1159/000431224
- A blueprint for obstetric critical care.Am J Obstet Gynecol. 2003; 188: 532-536https://doi.org/10.1067/mob.2003.95
- Risk factors for obstetric admissions to the intensive care unit in a tertiary hospital: a case-control study.Arch Gynecol Obstet. 2005; 272: 207-210https://doi.org/10.1007/s00404-004-0695-x
- Cohort study of near-miss maternal mortality and subsequent reproductive outcome.Eur J Obstet Gynecol Reprod Biol. 2002; 102: 173-178https://doi.org/10.1016/s0301-2115(01)00320-7
- Indications and outcome for intensive care unit admission during puerperium.Arch Gynecol Obstet. 2001; 265: 195-198https://doi.org/10.1007/s004040000160
- Multicenter study of obstetric admissions to 14 intensive care units in southern England.Crit Care Med. 2001; 29: 770-775https://doi.org/10.1097/00003246-200104000-00016
- Course and outcome of obstetric patients in a general intensive care unit.Acta Obstet Gynecol Scand. 2000; 79: 846-850
- Obstetric admissions to the intensive care unit: outcomes and severity of illness.Obstet Gynecol. 2003; 102: 897-903https://doi.org/10.1016/s0029-7844(03)00767-1
- Obstetric intensive care admissions: a 12-year review in a tertiary care centre.Eur J Obstet Gynecol Reprod Biol. 2006; 128: 152-156https://doi.org/10.1016/j.ejogrb.2005.12.013
- Critically ill obstetric patients in Australia: a retrospective audit of 8 years’ experience in a tertiary intensive care unit.Crit Care Resusc J Australas Acad Crit Care Med. 2008; 10: 124
- Systemic inflammatory response syndrome, organ failure, and outcome in critically ill obstetric patients treated in an ICU.Chest. 2001; 120: 1271-1277https://doi.org/10.1378/chest.120.4.1271
- Need for maternal critical care in obstetrics: a population-based analysis.Int J Obstet Anesth. 2002; 11: 260-264https://doi.org/10.1054/ijoa.2002.0985
- Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes.Intensive Care Med. 2005; 31: 1087-1094https://doi.org/10.1007/s00134-005-2710-5
- Analysis of disease in the obstetric intensive care unit at a university referral center: a 24-month review of prospective data.J Reprod Med. 2008; 53: 914-920
- Evaluation of standard and modified severity of illness scores in the obstetric patient.J Crit Care. 2011; 26: 535.e1-535.e7https://doi.org/10.1016/j.jcrc.2010.10.003
- Characteristics of obstetric intensive care unit admissions in New Jersey.J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2009; 22: 785-790https://doi.org/10.3109/14767050902874097
- Variability in intensive care unit admission among pregnant and postpartum women in Canada: a nationwide population-based observational study.Crit Care Lond Engl. 2019; 23: 381https://doi.org/10.1186/s13054-019-2660-x
- Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center.Obstet Gynecol Sci. 2018; 61: 209-219https://doi.org/10.5468/ogs.2018.61.2.209
- Obstetric Admissions to the Intensive Care Unit: A 18-year review in a Portuguese Tertiary Care Centre.Acta Med Port. 2019; 32: 693-696https://doi.org/10.20344/amp.11410
- Characteristics and preventability of obstetric intensive care unit admissions in Far North Queensland.Aust N Z J Obstet Gynaecol. 2020; 60https://doi.org/10.1111/ajo.13198
- Maternal near miss: what lies beneath?.Eur J Obstet Gynecol Reprod Biol. 2016; 199: 116-120https://doi.org/10.1016/j.ejogrb.2016.01.031
- Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006–2015.Birth Berkeley Calif. 2018; 45: 169-177https://doi.org/10.1111/birt.12330
- Maternal bacteremia and the Irish maternity early warning system.Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2015; 129: 142-145https://doi.org/10.1016/j.ijgo.2014.11.022
