Peripartum Intensive Care: Experience In An Urban Hospital Setting

INTRODUCTION: As women with co-morbid conditions become pregnant, it is not surprising that the rate of peripartum ICU admissions reflect this occurrence. Critically ill peripartum patients present a unique population, as the presence of a fetus, in conjunction with altered maternal physiology and a co-existing disease entity makes their care challenging. The purpose of this study is to describe the clinical characteristics of peripartum patients requiring intensive care in an urban hospital center. METHODS: IRB approved retrospective chart review of women admitted to the ICU between the first trimester of pregnancy through six weeks postpartum, from January 2014 through January 2017. Data collected on age, ethnicity, BMI, presence/absence of prenatal care, substance abuse and attendant co-morbidities for antepartum and postpartum patients. RESULTS: Seventy three patients were admitted to the ICU. The majority of the antepartum patients admitted lacked prenatal care, were noted to be tobacco/substance abusers; sepsis, DKA and respiratory dysfunction were the predominant morbidities. Conversely, the majority of the postpartum patients had prenatal care, and were morbidly obese; preeclampsia, cardiomyopathy and postpartum hemorrhage were the predominant morbidities. CONCLUSION: There exists a paucity of studies relating to peripartum intensive care--and of those, most focus on the postpartum aspect. The findings of this study are interesting in that both antepartum and postpartum patients were analyzed. Obesity confers a number of associated outcomes inclusive of hypertensive disorders and cardiac dysfunction. Our findings suggest that outreach programs directed to encouraging early prenatal care with screening for evidence of cardiac dysfunction/preeclampsia risk would be of benefit.