Critically ill obstetric and gynaecological patients in the intensive care unit.

OBJECTIVES: To document mortality among critically ill obstetric and gynaecological patients requiring intensive care unit (ICU) admission and to investigate whether any poor prognostic features could allow for earlier and more aggressive intervention.

STUDY DESIGN: A retrospective study of all obstetric and gynaecological patients admitted to the ICU of Johannesburg Hospital between 1985 and 1996. Sixty-one patients were analysed both as a group and as two subgroups--those with incomplete abortions and those with other pregnancy-related diagnoses.

RESULTS: Derangements in platelet counts, serum creatinine levels and prothrombin international normalised ratio (INR) were present in all patients on the day of admission to hospital. In the group with incomplete abortions absolute levels of these parameters may be used to identify those patients with a worse outcome. The mortality rate was 38%.

CONCLUSION: Early ICU admission and aggressive surgical intervention are strongly recommended in patients with septic incomplete abortions presenting with more than a single organ dysfunction.