International journal of obstetric anesthesia · 2026
Obstetric critical care admissions, organ support, and severe maternal morbidity in an Irish tertiary referral centre: a retrospective cohort study (2013-2023).
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Hartigan Sean, O'Loughlin Christopher, Costello Joseph, Cosgrave David, Hanley Ciara
Аннотация
BACKGROUND: Recent Irish and European reports have highlighted variation in obstetric critical care, but patient-level data spanning a longer timeframe from tertiary centres remain limited. In particular, few data describe how admission incidence, case mix, organ support requirements, and temporal trends vary within an integrated tertiary maternity and critical care model. We aimed to describe obstetric critical care admissions over 11-years at an Irish tertiary referral centre.
METHODS: We performed a retrospective cohort study of all pregnant and postpartum women admitted to the critical care unit at the Galway University Hospital from 2013 to 2023. Eligible cases were identified from critical care admission records and reviewed using the Metavision clinical information system, supplemented by paper chart review where necessary. Extracted data included patient and obstetric characteristics, indication for admission, level of care, organ support, acute kidney injury, critical care length of stay, and maternal mortality. Admission incidence was calculated per 1000 maternal deliveries. Temporal trends were assessed using logistic or linear regression, as appropriate.
RESULTS: There were 207 admissions, representing 6.7 per 1000 maternal deliveries. Sepsis (37.2%) and haemorrhage (28.0%) were the leading indications. A majority of women received level 2 care (76.5%), with respiratory support 55.0% of cases, vasopressor or inotropic support in 21.7% of cases, and renal replacement therapy 1.4% of cases. Mean length of stay in the critical care unit was 1.9 days. Vasopressor or inotropic use increased significantly over time (P = 0.025).
CONCLUSIONS: Obstetric critical care admission was uncommon and usually involved short-duration level 2 care. Sepsis predominated over haemorrhage, contrasting with recent Irish transfer data. These findings support interpreting admission rates alongside local service configuration, escalation pathways, and organ support practice.
METHODS: We performed a retrospective cohort study of all pregnant and postpartum women admitted to the critical care unit at the Galway University Hospital from 2013 to 2023. Eligible cases were identified from critical care admission records and reviewed using the Metavision clinical information system, supplemented by paper chart review where necessary. Extracted data included patient and obstetric characteristics, indication for admission, level of care, organ support, acute kidney injury, critical care length of stay, and maternal mortality. Admission incidence was calculated per 1000 maternal deliveries. Temporal trends were assessed using logistic or linear regression, as appropriate.
RESULTS: There were 207 admissions, representing 6.7 per 1000 maternal deliveries. Sepsis (37.2%) and haemorrhage (28.0%) were the leading indications. A majority of women received level 2 care (76.5%), with respiratory support 55.0% of cases, vasopressor or inotropic support in 21.7% of cases, and renal replacement therapy 1.4% of cases. Mean length of stay in the critical care unit was 1.9 days. Vasopressor or inotropic use increased significantly over time (P = 0.025).
CONCLUSIONS: Obstetric critical care admission was uncommon and usually involved short-duration level 2 care. Sepsis predominated over haemorrhage, contrasting with recent Irish transfer data. These findings support interpreting admission rates alongside local service configuration, escalation pathways, and organ support practice.