الفهرس 
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Abstract
P
regnant women are often young and in their reproductive years. In majority of them, pregnancy and labor usually progress uneventfully. Sudden complications occurring during this period may lead to maternal mortality. Though obstetric admission forms a small proportion of ICU admission, mortality among them is high. Proper antenatal care is still the mainstay of preventing complications in pregnant woman.
Obstetric admissions to the intensive care unit (ICU) require special care and attention by a multidisciplinary team. Obstetric patients admitted to intensive care unit (ICU) represent a challenge to intensivists due to the physiological adaptations and progress of disease during pregnancy and puerperium. The challenge is even more difficult because of the necessity to safeguard health of the mother and survival of the fetus. There is a striking connection between the number of maternal deaths and the accessibility to ICU care since the countries with the highest number of maternal deaths are also those with the lowest number of beds per capita in ICU.
Pregnancy, delivery and puerperium can be complicated by severe maternal morbidity necessitating ICU admission. The admission of obstetric patients to the ICU is a challenging task for an intensivist as these patients recover in a short period of time if their management is carried out at the earliest. Thus, it is of utmost importance to keep a continuous vigilance so as to ensure maternal safety.
In this study, we aimed to evaluate the incidence, characteristics, and mortality of pregnant and postpartum patients requiring ICU admission in Ain Shams University Maternity Hospital.
This retrospective analytic study was conducted at tertiary care hospital at Ain Shams University hospitals from Mars 2023 till October 2023 and performed on total 534 pregnant women who had admitted to the ICU during pregnancy or during the postpartum period (42 days after delivery) in a period from January 2018 till December 2022.
The current study revealed that Majority of the studied cases (90%) was within 20-39 years. Parity of 1-2 was 41.2% of the studied cases. About one third of cases (37.5%) had preterm pregnancy (<37 weeks). Multiple pregnancy was uncommon (1.7%).
As regards the causes of ICU admission, the current research study revealed that SPET was the most common obstetric causes of ICU admission (35.2%); followed by Placenta previa (13.9%), IUFD (11.4%) and HEG (8.8%) while the most common non-obstetric causes were PGDM (12.2%), cardiac valvular diseases (6.4%) and Epilepsy (2.4%). Conservative management was needed in 23.2% of the studied cases. LSCS was the most frequent surgical intervention (56.2%); while Hysterectomy was performed in (10.5%) of the studied cases.
As regards maternal morbidity and mortality, our study results revealed that Anemia was the most frequent morbidity (46.8%), followed by blood transfusion (27.9%) and plasmapheresis (24.2%). Of the 534 obstetrical patients admitted to the ICU, 521 of the 534 were discharged while 13 patients died, the Maternal mortality rate was 2.4%.
As regards the fetal outcome, our study results revealed that NICU needed is more than quarter of the studied cases (27.9%). Fetal mortality occurred in more than one tenth of the studied cases (16.7%).
As regards maternal outcome, our study results revealed that IUFD, Eclampsia, Jaundice and Shock were significantly more frequent in maternal mortality cases than survival cases while there were no statistically significant differences between them regarding maternal, fetal demographic characteristics, other clinical presentations and surgical interventions.
As regards maternal and fetal mortality, our study results revealed that Anemia, Blood transfusion, Plasmapheresis and Hemodialysis were significantly more frequent in maternal mortality cases and fetal mortality was significantly more frequent in maternal mortality cases. APH and Impending rupture uterus were significantly more frequent in cases of fetal mortality.
Moreover, Conservative and LSCS were significantly less frequent in fetal mortality cases while SVD, D&C, Laparotomy and Surgical evacuation were significantly more frequent in fetal mortality cases. Maternal anemia, Plasmapheresis and mortality were significantly more frequent in fetal mortality cases.
We concluded that This study demonstrated the characteristics of the critically ill obstetric patients admitted to our ICU in a 5-year period from 2018 to 2023. The main causes were hypertensive disorders of pregnancy (Severe Pre-eclampsia) and hemorrhagic complications due to anemia. Improving antenatal care may help to reduce obstetric ICU admission rate. Maternal mortality was 2.4% which was similar to reports in other studies from intensive care units and Fetal mortality rate was 16.7%.
We recommend early admission and appropriate management of critical obstetrical patients to the ICU to decrease maternal and fetal morbidity and mortality.