Pregnancy and postpartum-related admissions to the intensive care unit at a tertiary centre in Northwest China: a 14-year retrospective study.

BACKGROUND

The purpose of this study was to analyse the incidence of maternal morbidity and mortality of pregnant and postpartum women admitted to the intensive care unit (ICU).

METHODS

In this study, we retrospectively analyzed all pregnant and postpartum patients admitted to the ICU of the intensive care unit at our tertiary center in northwest China between January 1, 2009 and December 31, 2022.

RESULTS

A total of 528 patients with pregnancy and postpartum related morbidities were admitted to the ICU (5.16 per 1000 deliveries). It accounted for 11.73% of all adult admissions to the unit. The median age was 28 years, the median gestation time was 37 weeks, and 89.98% did not receive irregular prenatal care. 182 (34.47%) were primiparous. Most of admitting in postpartum (99.24%) and 48.67% were premature. The main reasons for admission included postpartum hemorrhage (PPH) (180/528), hypertensive disorders pregnancy (176/528), and cardiac diseases (69/528). The median length of ICU stay was four days (2-6), and the median APACHE II score was 12.5 points. 185 patients (35.04%) required invasive mechanical ventilation, 25 (4.73%) had non-invasive ventilation, 85(16.1%) required vasoactive drugs, 14 patients (2.65%) underwent renal replacement therapy, and 69 patients (13.07%) underwent hysterectomy. When comparing the rates of maternal mortality between 2009 and 2015 and 2016-2022, a decreasing trend was revealed (2.98% vs. 1.04%; P = 0.151), and stillbirth (19.64% vs. 20.83%, P = 0.743) did not decrease significantly, whereas the rates of ICU admission did (19.26% vs. 6.63%; p trends < 0.01). We reported 12 maternal deaths (2.27%; 11.7 per 100,0000 deliveries), and 9 maternal deaths due to obstetric factors. There were 106 cases of fetal death.

CONCLUSIONS

There are three main reasons for obstetric ICU admissions: postpartum hemorrhage, hypertensive disorders of pregnancy, and cardiac diseases. The majority of obstetric patients admitted to the ICU do not require multi-organ supportive therapy. The main cause of maternal mortality was obstetric factors. Pregnant women having a second child and diabetes are more likely to have stillbirth.