Cartin-Ceba Rodrigo, Gajic Ognjen, Iyer Vivek N, Vlahakis Nicholas E
Mayo Clinic of Medicine, Rochester, MN, USA.
Crit Care Med. 2008 Oct;36(10):2746-51. doi: 10.1097/ccm.0b013e318186b615.
The outcome of the fetus in critically ill mothers has been briefly reported as a part of descriptive studies focusing on maternal risk factors for admission to the intensive care unit. We evaluated the risk factors for adverse fetal outcomes in critically ill pregnant women admitted to the intensive care unit for nonobstetrical reasons.
Retrospective cohort study of all critically ill pregnant patients >18 yr; admitted to four (medical, surgical, trauma, and mixed medical-surgical) intensive care units at the Mayo Clinic in Rochester, MN; during the period of January 1995 to December 2005. Only pregnant women admitted to the intensive care unit in the antepartum period for nonobstetrical indications were included. Main predictors for fetal outcomes included: maternal comorbidities, obstetrical history, intensive care unit interventions, and intensive care unit complications. Fetal outcomes were defined as spontaneous abortions, neonatal mortality, fetal deaths, admission to the neonatal intensive care unit, neonatal intensive care unit length of stay, and neonatal intensive care unit complications.
A total of 153 adult women (>18 yr) with a diagnosis of pregnancy were admitted to the intensive care unit, of whom 93 pregnant women met the inclusion criteria. Median maternal age was 26 yr (interquartile range 22-33) and median gestational age was 25 wk (interquartile range 8-33). The median maternal Acute Physiologic and Chronic Health Evaluation III score was 27 (interquartile range 17-38). There were 32 fetal losses; 18 were spontaneous abortions and 14 were fetal deaths. Ten neonates required neonatal intensive care unit admission, five for respiratory distress syndrome; and only one neonate died. The median neonatal intensive care unit length of stay was 34 days (interquartile range 15-87). After multivariable logistic regression analysis, the risk factors associated with fetal loss were: presence of maternal shock, odds ratio 6.85 (95% confidence interval 1.16-58, p = 0.04); maternal transfusion of blood products, odds ratio 7.24 (95% confidence interval 1.4-49, p = 0.02); and gestational age, odds ratio 1.2 for every gestational week below 37 wk (95% confidence interval 1.1-1.3, p < 0.001).
Nonobstetrical critical illness in pregnant women significantly affects fetal and neonatal outcomes. Maternal shock, maternal requirement of allogenic blood product transfusion and lower gestational age were associated with an increased risk of fetal loss.
作为关注入住重症监护病房孕产妇风险因素的描述性研究的一部分，曾简要报道过危重症孕产妇的胎儿结局。我们评估了因非产科原因入住重症监护病房的危重症孕妇出现不良胎儿结局的风险因素。
对1995年1月至2005年12月期间在明尼苏达州罗切斯特市梅奥诊所四个（内科、外科、创伤及内科 - 外科混合）重症监护病房入住的所有年龄大于18岁的危重症孕妇进行回顾性队列研究。仅纳入因非产科指征在产前入住重症监护病房的孕妇。胎儿结局的主要预测因素包括：孕产妇合并症、产科病史、重症监护病房干预措施及重症监护病房并发症。胎儿结局定义为自然流产、新生儿死亡、胎儿死亡、入住新生儿重症监护病房、新生儿重症监护病房住院时长及新生儿重症监护病房并发症。
共有153名诊断为妊娠的成年女性入住重症监护病房，其中93名孕妇符合纳入标准。孕产妇年龄中位数为26岁（四分位间距22 - 33岁），孕周中位数为25周（四分位间距8 - 33周）。孕产妇急性生理与慢性健康状况评估III评分中位数为27分（四分位间距17 - 38分）。发生32例胎儿丢失；18例为自然流产，14例为胎儿死亡。10名新生儿需要入住新生儿重症监护病房，5名因呼吸窘迫综合征；仅1名新生儿死亡。新生儿重症监护病房住院时长中位数为34天（四分位间距15 - 87天）。多变量逻辑回归分析后，与胎儿丢失相关的风险因素为：孕产妇休克，比值比6.85（95%置信区间1.16 - 58，p = 0.04）；孕产妇输注血制品，比值比7.24（95%置信区间1.4 - 49，p = 0.02）；孕周，每低于37周1个孕周比值比为1.2（95%置信区间1.1 - 1.3，p < 0.001）。
孕妇的非产科危重症显著影响胎儿及新生儿结局。孕产妇休克、孕产妇对异体血制品输血的需求及较低孕周与胎儿丢失风险增加相关。
