Introduction: Obstetric patients are different from the usual patients admitted to ICU. They have unique physiology and specific medical problems that represent a special challenge to intensive care physicians. Due to the advances of many prenatal monitoring techniques and improvement in socio-economic conditions, the causes of obstetric patients requiring ICU admission may be different from the past.
Objective: The primary objective of the study was to review the characteristics of the obstetric patients admitted to our ICU in a 10-year period for both obstetric-related and non-obstetric-related causes. Our secondary objectives were to study APACHE II, SAPS II and SOFA as related to the clinical outcomes, as well as to assess the health related quality of life (HRQOL) outcome and compare and contrast our findings with overseas studies.
Methods: A retrospective cohort study of obstetric patients admitted to Pamela Youde Nethersole Eastern Hospital ICU from Jan 1998 to Dec 2007.
Results: 50 obstetric patients (mean age 31.4 ± 5.6 years; mean gestational age 33.6 ± 8.6 weeks) were analyzed. The mean APACHE II score was 14.9, with an actual mortality 6% and standard mortality ratio (SMR) 0.21. The mean SAPS II score and SOFA score was 27.4 and 3.4 respectively, and both were higher in the non-survivors. The commonest obstetric cause of admission was postpartum haemorrhage (n=19, 38%), followed by pregnancy-induced hypertension (n=7, 14%). The commonest non-obstetric cause of admission was sepsis (n=7, 14%). The commonest intervention was arterial line insertion (n=33, 66%) and mechanical ventilation (n=29, 58%). Maternal mortality was 6% (n=3), while the perinatal mortality was 8% (n=4). The average SF-36 scores of our patients were lower than the norm of Hong Kong population of the same sex and age group.
Conclusion: Postpartum haemorrhage and pregnancy-induced hypertension were the commonest causes of admission. Overall mortality rate was low. APACHE II score over-estimated the actual mortality. SAPS II and SOFA scores were much higher in the non-survivors than the survivors. Long-term health related quality of life in discharged patients as assessed by the SF-36 score was lower than the norm of the Hong Kong population. Further development and studies in antenatal care, haemostatic methods, disease severity score usage and long-term psychosocial follow-up are all worthwhile.
Dr LEUNG Yuk Wah, Natalie, Pamela Youde Nethersole Eastern Hospital, November 2008