Category: Obstetric Quality and Safety
Poster Session IV
As rates of maternal morbidity and mortality are rising in the United States, postpartum (PP) obstetrical intensive care units (ICU) admission is rare, but a clinically significant event. We examined risk factors for obstetrical ICU admissions as well as perinatal outcomes in patients with a PP obstetric ICU admission.
Study Design:
Retrospective cohort study of deliveries greater than 20 weeks gestation at a large, tertiary care center from 2013-2018. Baseline demographics, prenatal, medical and delivery characteristics (exposures) were ascertained from the medical record. The primary outcome was admission to the ICU any time after delivery up to 6 weeks postpartum. A multivariable logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals for the association between exposures of interest and PP ICU admission. In addition, select perinatal outcomes (such as maternal death, transfusion, VTE, and neonatal outcomes) were compared between patients with and without a PP ICU admission and evaluated at significance level of 0.05.
Results:
Of 23,966 patients, 163 (0.7%) had a PP admission to the ICU. Patients who had a cesarean delivery, anemia on admission, pre-eclampsia, postpartum hemorrhage, endometritis and congestive heart failure had a higher odds of ICU admission on multivariable analysis (Table 1). Of note, patients with congestive heart failure (OR 44, 95%CI 22-91) and postpartum hemorrhage (OR 5, 95% CI 3.5-8.2) had the highest odds of ICU admission. When evaluating perinatal outcomes, patients admitted to the ICU were also more likely to require blood transfusion, have had adverse neonatal outcomes, and experience maternal death (Table 2).
Conclusion:
Patients who are admitted to the ICU are significantly more likely to have certain medical and obstetrical comorbidities and experience significant maternal and neonatal adverse outcomes. Developing models to predict ICU admission incorporating these characteristics could be useful in reducing severe maternal and neonatal morbidity.
Kevin S. Shrestha, MD, MPH
Resident
University of Alabama at Birmingham
Birmingham, Alabama, United States
Ayodeji Sanusi, MD, MPH
Fellow/ Clinical Instructor
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Gerald McGwin, MS, PhD
Professor/ Vice chairman
Department of Epidemiology, University of Alabama at Birmingham
Birmingham, Alabama, United States
Ashley N. Battarbee, MD,MSCR
Assistant Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States