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Epidemiology of Obstetric-Related ICU Admissions in Maryland: 19992008*

Wanderer, Jonathan P. MD, MPhil1; Leffert, Lisa R. MD2; Mhyre, Jill M. MD3; Kuklina, Elena V. MD, PhD4; Callaghan, William M. MD, MPH5; Bateman, Brian T. MD2

doi: 10.1097/CCM.0b013e31828a3e24
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Objective: To define the prevalence, indications, and temporal trends in obstetric-related ICU admissions.

Design: Descriptive analysis of utilization patterns.

Setting: All hospitals within the state of Maryland.

Patients: All antepartum, delivery, and postpartum patients who were hospitalized between 1999 and 2008.

Interventions: None.

Measurements and Main Results: We identified 2,927 ICU admissions from 765,598 admissions for antepartum, delivery, or postpartum conditions using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. The overall rate of ICU utilization was 419.1 per 100,000 deliveries, with rates of 162.5, 202.6, and 54.0 per 100,000 deliveries for the antepartum, delivery, and postpartum periods, respectively. The leading diagnoses associated with ICU admission were pregnancy-related hypertensive disease (present in 29.9% of admissions), hemorrhage (18.8%), cardiomyopathy or other cardiac disease (18.3%), genitourinary infection (11.5%), complications from ectopic pregnancies and abortions (10.3%), nongenitourinary infection (10.1%), sepsis (7.1%), cerebrovascular disease (5.8%), and pulmonary embolism (3.7%). We assessed for changes in the most common diagnoses in the ICU population over time and found rising rates of sepsis (10.1 per 100,000 deliveries to 16.6 per 100,000 deliveries, p = 0.003) and trauma (9.2 per 100,000 deliveries to 13.6 per 100,000 deliveries, p = 0.026) with decreasing rates of anesthetic complications (11.3 per 100,000 to 4.7 per 100,000, p = 0.006). The overall frequency of obstetric-related ICU admission and the rates for other indications remained relatively stable.

Conclusions: Between 1999 and 2008, 419.1 per 100,000 deliveries in Maryland were complicated by ICU admission. Hospitals providing obstetric services should plan for appropriate critical care management and/or transfer of women with severe morbidities during pregnancy.

1Department of Anesthesia, Vanderbilt University, Nashville, TN.

2Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.

3Department of Anesthesiology, The University of Michigan Health System, Ann Arbor, MI.

4Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Washington, DC.

5Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Washington, DC.

*See also p. 2031.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Supported, in part, by Massachusetts General Hospital departmental and National Institute of Health funds (BTB, grant GM007592).

Dr. Mhyre has received royalties from Chestnut Principles and Practices of Anesthesia, 5th Ed; payment for development of educational presentations from NY PGA 66th Assembly; travel/accommodations from ACOG Maternal Mortality Expert Panel, Joint Commission Panel on High Risk Pregnancy. Dr. Bateman received funding from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: jonathan.p.wanderer@vanderbilt.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins