L Barrett Helen, Devin Ruth, Clarke Sophie, Dekker Nitert Marloes, Boots Robert, Fagermo Narelle, K Callaway Leonie, Lust Karin
Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.
Obstet Med. 2012 Dec;5(4):166-170. doi: 10.1258/om.2012.120033. Epub 2012 Nov 5.
Maternal mortality is a rare occurrence in developed nations. Given the low maternal mortality rate, other markers must be used to assess maternal risk and quality of obstetric care. One such is admission to critical care.
To determine the rate of admission, diagnosis and management of women from conception and up to 6 weeks postpartum to critical care units including coronary care (CCU), high dependency unit (HDU) and intensive care units (ICU).
We performed a retrospective review of obstetric patients requiring critical care admission from January 1995 to August 2010. Demographic details, obstetric history, place of admission (CCU, HDU or ICU) and fetal/neonatal outcomes were examined as were initial indication for critical care admission, final diagnosis and treatment administered.
Data were available from 308 admission incidents. There were 259 (84%) admissions to ICU and 49 (15.9%) to CCU. More than a third of women were transferred from another institution. Those women transferred were more unwell and had a higher mortality rate than local women. Primary diagnoses: obstetric haemorrhage (ICU 30.9%), hypertensive disorders of pregnancy (ICU 16.2%, CCU 12.2%), infection (ICU 14.2%, CCU 6.1%), pre-existing cardiac disease (ICU 9.3%, CCU 55.1%).
The obstetric population represents only a small percentage of critical care utilisation and overall morbidity and mortality. However, this population is an important and growing group. Increased surveillance peripartum in a critical care facility allows earlier detection of maternal compromise and detailed management. Analysis of these 'near misses' in obstetrics aims to improve pregnancy outcomes.
孕产妇死亡在发达国家较为罕见。鉴于孕产妇死亡率较低，必须使用其他指标来评估孕产妇风险和产科护理质量。其中之一就是入住重症监护病房。
确定从受孕到产后6周的女性入住包括冠心病监护病房（CCU）、高依赖病房（HDU）和重症监护病房（ICU）在内的重症监护病房的入住率、诊断和管理情况。
我们对1995年1月至2010年8月期间需要入住重症监护病房的产科患者进行了回顾性研究。研究了人口统计学细节、产科病史、入住地点（CCU、HDU或ICU）以及胎儿/新生儿结局，同时也研究了入住重症监护病房的初始指征、最终诊断和所给予的治疗。
有308次入住事件的数据。其中259例（84%）入住ICU，49例（15.9%）入住CCU。超过三分之一的女性是从其他机构转来的。那些转来的女性病情更严重，死亡率高于当地女性。主要诊断：产科出血（ICU为30.9%）、妊娠高血压疾病（ICU为16.2%，CCU为12.2%）、感染（ICU为14.2%，CCU为6.1%）、既往心脏病（ICU为9.3%，CCU为55.1%）。
产科人群在重症监护病房的使用以及总体发病率和死亡率中仅占一小部分。然而，这一人群是一个重要且不断增长的群体。在重症监护设施中加强围产期监测可更早发现孕产妇健康问题并进行详细管理。对产科这些“险些发生的失误”进行分析旨在改善妊娠结局。
