Department of Obstetrics, K6-P-35, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
Intensive Care Med. 2010 Feb;36(2):256-63. doi: 10.1007/s00134-009-1707-x. Epub 2009 Nov 10.
As part of a larger nationwide enquiry into severe maternal morbidity, our aim was to assess the incidence and possible risk factors of obstetric intensive care unit (ICU) admission in the Netherlands.
In a 2-year nationwide prospective population-based cohort study, all ICU admissions during pregnancy, delivery and puerperium (up to 42 days postpartum) were prospectively collected. Incidence, case fatality rate and possible risk factors were assessed, with special attention to the ethnic background of women.
All 98 Dutch maternity units participated in the study. There were 847 obstetric ICU admissions in 358,874 deliveries, the incidence being 2.4 per 1,000 deliveries. Twenty-nine maternal deaths occurred, resulting in a case fatality rate of 1 in 29 (3.5%). Incidence of ICU admission varied largely across the country. Thirty-three percent of all cases of severe maternal morbidity were admitted to an ICU. Most frequent reasons for ICU admission were major obstetric haemorrhage (48.6%), hypertensive disorders of pregnancy (29.3%) and sepsis (8.1%). Assisted ventilation was needed in 34.8%, inotropic support in 8.8%. In univariable analysis, non-Western immigrant women had a 1.4-fold (95% CI 1.2-1.7) increased risk of ICU admission as compared to Western women. Initial antenatal care by an obstetrician was associated with a higher risk and home delivery with a lower risk of ICU admission.
Population-based incidence of obstetric ICU admission in the Netherlands was 2.4 per 1,000 deliveries. Obstetric ICU admission accounts for only one-third of all cases of severe maternal morbidity in the Netherlands.
作为一项全国范围内严重孕产妇发病率调查的一部分，我们旨在评估荷兰产科重症监护病房（ICU）入院的发生率和可能的危险因素。
在一项为期 2 年的全国前瞻性基于人群的队列研究中，前瞻性收集了所有妊娠、分娩和产褥期（产后 42 天内）的 ICU 入院病例。评估了发生率、病死率和可能的危险因素，并特别关注了妇女的种族背景。
所有 98 家荷兰产科单位均参与了该研究。在 358874 例分娩中，有 847 例产科 ICU 入院，发生率为每 1000 例分娩 2.4 例。发生了 29 例孕产妇死亡，病死率为 1 例/29 例（3.5%）。ICU 入院率在全国范围内差异很大。33%的严重孕产妇发病率患者被收入 ICU。ICU 入院的最常见原因是产科大出血（48.6%）、妊娠高血压疾病（29.3%）和败血症（8.1%）。需要辅助通气的病例占 34.8%，需要正性肌力支持的病例占 8.8%。单变量分析显示，与西方妇女相比，非西方移民妇女 ICU 入院的风险增加 1.4 倍（95%CI 1.2-1.7）。最初由产科医生进行的产前保健与 ICU 入院风险增加相关，而家庭分娩与 ICU 入院风险降低相关。
荷兰产科 ICU 入院的基于人群的发生率为每 1000 例分娩 2.4 例。产科 ICU 入院仅占荷兰严重孕产妇发病率的三分之一。
