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Critical care in obstetrics: Clinical audit in the Republic of Ireland, 2014–2016

Published:November 08, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.10.008

      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

      Admission to an Intensive Care Unit (ICU) in obstetrics is often used as a proxy for maternal near miss/severe maternal morbidity (MNM/SMM) events. Understanding incidence and management of pregnant or postpartum patients requiring critical care (CC) is thus important for continued improvement of maternity care. This study aims to describe provision of critical care in obstetrics in the Republic of Ireland.

      Material and methods

      The national clinical audit on critical care included 15 of 19 maternity units in Ireland (2014–2016). 960 pregnant or postpartum (within 42 days) individuals who required CC were included. Data were reported on all cases requiring level 2 or level 3 CC. We calculated basic descriptive statistics for diagnosis and process of care variables, and compared characteristics of women requiring level 2 care to those requiring level 3. Outcomes included diagnoses necessitating critical care; additional complications; level of care required; care process outcomes such as length of stay, consultation with non-obstetric specialties, location of maternal critical care, and neonatal care provision.

      Results

      Overall, the rate of critical care in obstetrics for these hospitals was 1 in 131 live births; 900 of the 960 cases required level 2 care only. Hypertensive disorders contributed to the need for critical care for 1 in 242; hemorrhage, 1 in 422; and infections, 1 in 926. A substantial minority (15.7%) had more than one diagnosis, accounting for 40% of level 3 care. Serious complications were rare (eg, hysterectomy, 1 in 3846). Parity, hospital size, and identification as high-risk antenatally (<50% cases) were associated with requiring level 3 care. Critical care was provided in multiple locations, including ICUs, HDUs, and operating theatres. Only 23.8% of patients received CC in an ICU, suggesting ICU admission is not an ideal method for identifying severe maternal morbidity.

      Conclusions

      We reported rates of critical care admission and primary diagnoses within the range of other published estimates, but huge variability exists in the literature, and within our data. ICU admission in and of itself iss not a reliable proxy for having received level 2 or 3 obstetric critical care in Ireland.

      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)
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