Maternal Critical Care: Outcomes and Patient Characteristics in a Combined Obstetric High Dependency Unit in Medellín, Colombia
Keywords:
Maternal mortality, pre-eclampsia, eclampsia, hemorrhage
Abstract
The critically ill obstetric patient represents a complex clinical challenge that requires a multi-disciplinary approach. The aim of our study was to assess the utilization rate, admission diagnosis and maternal-fetal outcome of critically ill obstetrical patients admitted in a single institution high dependency/Intensive care Unit in Colombia, Latin America. A 3-year retrospective review of hospital records was completed. Eight hundred and nineteen patients were admitted in a 3 year period, representing 3.3 % of all deliveries, 64 % of the admissions were in the antepar-tum period. Obstetric complications accounted for 82 % of admissions; the preeclampsia - eclampsia and its complications were the most common diagnosis (50.5 %) and obstetric hemorrhage was the primary cause of severe morbidity and mortality. There were seven deaths (0.85 %). The average length of stay at the unit was 2.41 days (1-15). Nine patients were transferred to a medical/surgical Intensive Care Unit during the study. Uses of an exclusive Obstetric high dependency unit includes the concurrent availability of an obstetric, perinatal and critical care management, with low threshold for admission either antenatal or in the postnatal period, that allow an efficient and opportune management of the complex obstetric patient.
References
1. Hazelgrove JF, Price C, Pappachan VJ, et al. Multicenter study of obstetric admissions to 14 intensive care units in southern England. Crit Care Med. 2001;29:770-5.
2. Bouvier-Colle MH, Salanave B, Ancel PY, et al. Obstetric patients treated in intensive care units and mortality. Eur J Obstet Gynecol Reprod Biol. 1996;65:121-5.
3. Dias de Souza JP, Duarte G, Basile-Filho A. Near-miss maternal mortality in developing countries. Eur J Obstet Gynecol Reprod Biol. 2002;104:80.
4. Kilpatrick SJ, Matthay MA. Obstetric patients requiring critical care. A five year review. Chest. 1992;101:1407-12.
5. Vásquez DN, Estenssoro E, Canales HS, et al. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest. 2007;131: 718-24.
6. Collop NA, Sahn SA. Critical illness in pregnancy. An analysis of 20 patients admitted to a medical intensive care unit. Chest. 1993;103:1548-52.
7. Panchal S, Arria A, Harris P, et al. Intensive care utilization during hospital admission for delivery. Anesthesiology. 2000;92:1537-44.
8. Ryan M, Hamilton V, Bowen M, et al. The role of a high-dependency unit in a regional obstetric hospital. Anaesthesia 2000;55:1155-58.
9. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
10. Antonelli M, Levy M, Andrews PJ, et al. Hemodynamic monitoring in shock and implications for management. International Consensus Conference. Intensive Care Med. 2007;33:575-90.
11. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818-24.
12. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23: 1638-52.
13. Taylor FB Jr, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327-30.
14. World Health Organization (WHO). International statistical classification of diseases and related health problems, 10th revision. Geneva: WHO; 1992.
15. Lapinsky SE, Kruczyinski K, Slutsky AS. Critical care in the pregnant patient. Am J Respir Crit Care Med. 1995;152:427-55.
16. Lapinsky SE, Kruczynski K, Seaward GR, et al. Critical care management of the obstetric patient. Can J Anaesth. 1997;44:325-29.
17. Zeeman GG, Wendel GD Jr, Cunningham FG. A blueprint for obstetric critical care. Am J Obstet Gynecol. 2003;188:532-6.
18. Saravanakumar K, Davies L, Lewis M, et al. High dependency care in an obstetric setting in the UK. Anaesthesia. 2008;63:1081-6.
19. Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gy-naecol. 1998;105:981-4.
20. Karnad DR, Lapsia V, Krishnan A, et al. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med. 2004;32:1294-9.
21. Munnur U, Karnad DR, Bandi VD, et al. 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;31:1087-94.
22. Mahutte NG, Murphy-Kaulbeck L, Le Q, et al. Obstetric admissions to the intensive care unit. Obstet Gynecol. 1999;94:263-6.
23. Martin JN Jr, Thigpen BD, Moore RC, et al. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105:246-54.
24. Sibai BM, Mabie BC, Harvey CJ, et al. Pulmonary edema in severe preeclampsia-eclampsia: analysis of thirty-seven consecutive cases. Am J Obstet Gynecol. 1987;156:1174-9.
25. Gilbert WM, Towner DR, Field NT, et al. The safety and utility of pulmonary artery catheterization in severe preeclampsia and eclampsia. Am J Obstet Gynecol. 2000;182:1397-403.
26. Drakeley AJ, Le Roux PA, Anthony J, et al. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol. 2002;186:253-6.
27. Cardona A; Monsalve G; Vasco M, et al. Obstetric hemorrhage: morbidity and mortality in a high dependency unit in Medellin, Colombia South America. Poster presentations. Journal of Perinatal Medicine. 2007;35(s2):S101-S301.
28. Flood KM, Said S, Geary M, et al. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol. 2009;200:632.e1-6.
29. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med. 2008;359: 2025-33.
30. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.
31. Monsalve G, Arango G, Osorio A, Arango J, Mojica L, et al. Early Goal Directed Therapy (EGDT) for severe sepsis and sep- tic shock in the pregnant patient. outcome in 34 consecutive patients. Anesth Analg. 2008; 106:A-202.
32. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.
33. Sosa CG, Althabe F, Belizán JM, et al. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol. 2009;113:1313-9.
34. Hay JE. Liver disease in pregnancy. Hepatology. 2008;47:1067-76.
35. Moore J, Baldisseri MR. Amniotic fluid embolism. Crit Care Med. 2005;33:S279-85.
36. Harrison DA, Penny JA, Yentis SM, Fayek S. Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Mix Programme Database. Critical Care. 2005;9:S25-37.
37. Pollock W, Rose L, Dennis CL. Pregnant and postpar-tum admissions to the intensive care unit: a systematic review. Intensive Care Med. 2010;36:1465-74.
2. Bouvier-Colle MH, Salanave B, Ancel PY, et al. Obstetric patients treated in intensive care units and mortality. Eur J Obstet Gynecol Reprod Biol. 1996;65:121-5.
3. Dias de Souza JP, Duarte G, Basile-Filho A. Near-miss maternal mortality in developing countries. Eur J Obstet Gynecol Reprod Biol. 2002;104:80.
4. Kilpatrick SJ, Matthay MA. Obstetric patients requiring critical care. A five year review. Chest. 1992;101:1407-12.
5. Vásquez DN, Estenssoro E, Canales HS, et al. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest. 2007;131: 718-24.
6. Collop NA, Sahn SA. Critical illness in pregnancy. An analysis of 20 patients admitted to a medical intensive care unit. Chest. 1993;103:1548-52.
7. Panchal S, Arria A, Harris P, et al. Intensive care utilization during hospital admission for delivery. Anesthesiology. 2000;92:1537-44.
8. Ryan M, Hamilton V, Bowen M, et al. The role of a high-dependency unit in a regional obstetric hospital. Anaesthesia 2000;55:1155-58.
9. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
10. Antonelli M, Levy M, Andrews PJ, et al. Hemodynamic monitoring in shock and implications for management. International Consensus Conference. Intensive Care Med. 2007;33:575-90.
11. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818-24.
12. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23: 1638-52.
13. Taylor FB Jr, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327-30.
14. World Health Organization (WHO). International statistical classification of diseases and related health problems, 10th revision. Geneva: WHO; 1992.
15. Lapinsky SE, Kruczyinski K, Slutsky AS. Critical care in the pregnant patient. Am J Respir Crit Care Med. 1995;152:427-55.
16. Lapinsky SE, Kruczynski K, Seaward GR, et al. Critical care management of the obstetric patient. Can J Anaesth. 1997;44:325-29.
17. Zeeman GG, Wendel GD Jr, Cunningham FG. A blueprint for obstetric critical care. Am J Obstet Gynecol. 2003;188:532-6.
18. Saravanakumar K, Davies L, Lewis M, et al. High dependency care in an obstetric setting in the UK. Anaesthesia. 2008;63:1081-6.
19. Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gy-naecol. 1998;105:981-4.
20. Karnad DR, Lapsia V, Krishnan A, et al. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med. 2004;32:1294-9.
21. Munnur U, Karnad DR, Bandi VD, et al. 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;31:1087-94.
22. Mahutte NG, Murphy-Kaulbeck L, Le Q, et al. Obstetric admissions to the intensive care unit. Obstet Gynecol. 1999;94:263-6.
23. Martin JN Jr, Thigpen BD, Moore RC, et al. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105:246-54.
24. Sibai BM, Mabie BC, Harvey CJ, et al. Pulmonary edema in severe preeclampsia-eclampsia: analysis of thirty-seven consecutive cases. Am J Obstet Gynecol. 1987;156:1174-9.
25. Gilbert WM, Towner DR, Field NT, et al. The safety and utility of pulmonary artery catheterization in severe preeclampsia and eclampsia. Am J Obstet Gynecol. 2000;182:1397-403.
26. Drakeley AJ, Le Roux PA, Anthony J, et al. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol. 2002;186:253-6.
27. Cardona A; Monsalve G; Vasco M, et al. Obstetric hemorrhage: morbidity and mortality in a high dependency unit in Medellin, Colombia South America. Poster presentations. Journal of Perinatal Medicine. 2007;35(s2):S101-S301.
28. Flood KM, Said S, Geary M, et al. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol. 2009;200:632.e1-6.
29. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med. 2008;359: 2025-33.
30. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.
31. Monsalve G, Arango G, Osorio A, Arango J, Mojica L, et al. Early Goal Directed Therapy (EGDT) for severe sepsis and sep- tic shock in the pregnant patient. outcome in 34 consecutive patients. Anesth Analg. 2008; 106:A-202.
32. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.
33. Sosa CG, Althabe F, Belizán JM, et al. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol. 2009;113:1313-9.
34. Hay JE. Liver disease in pregnancy. Hepatology. 2008;47:1067-76.
35. Moore J, Baldisseri MR. Amniotic fluid embolism. Crit Care Med. 2005;33:S279-85.
36. Harrison DA, Penny JA, Yentis SM, Fayek S. Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Mix Programme Database. Critical Care. 2005;9:S25-37.
37. Pollock W, Rose L, Dennis CL. Pregnant and postpar-tum admissions to the intensive care unit: a systematic review. Intensive Care Med. 2010;36:1465-74.
How to Cite
1.
Monsalve GA, Martínez CM, Gallo T, González MV, Arango G, Upegui A, et al. Maternal Critical Care: Outcomes and Patient Characteristics in a Combined Obstetric High Dependency Unit in Medellín, Colombia. Colomb. J. Anesthesiol. [Internet]. 2011 Apr. 1 [cited 2024 Apr. 24];39(2):190-205. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/748
Downloads
Download data is not yet available.
Published
2011-04-01
How to Cite
1.
Monsalve GA, Martínez CM, Gallo T, González MV, Arango G, Upegui A, et al. Maternal Critical Care: Outcomes and Patient Characteristics in a Combined Obstetric High Dependency Unit in Medellín, Colombia. Colomb. J. Anesthesiol. [Internet]. 2011 Apr. 1 [cited 2024 Apr. 24];39(2):190-205. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/748
Issue
Section
Original
Altmetric
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
