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Obstetric admissions to intensive care unit : an 11-years retrospective study
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Introdução: A mortalidade materna tem diminuído significativamente nas últimas décadas, sobretudo em países desenvolvidos. Grávidas e puérperas raramente requerem internamento em Unidade de Cuidados Intensivos (UCI). Atualmente há poucos estudos sobre a morbimortalidade em doença obstétrica crítica. O objetivo deste estudo foi avaliar as complicações obstétricas mais comuns a requerer internamento em UCI. Métodos: Trata-se de um estudo observacional de coorte retrospetivo de todas as grávidas e puérperas admitidas numa UCI de um hospital terciário universitário entre Janeiro de 2012 e Janeiro de 2023. Os dados foram colhidos a partir de processos eletrónicos. Resultados: Incluiu-se um total de 102 internamentos em UCI, correspondentes a 100 doentes. 89 (87.3%) eram puérperas e 13 (12.7%) grávidas. A média de idades foi de 33±6.6 anos. 38 (37.3%) doentes tiveram dois ou mais motivos de internamento e os mais frequentes foram doença hipertensiva da gravidez (49%), hemorragia pós-parto (45.1%) e infeção (18.6%). As complicações mais comuns foram lesão renal aguda (26.5%) e insuficiência respiratória (23.5%). Cerca de 55% dos internamentos precisaram de suporte de órgão tal como transfusão sanguínea (40.2%), ventilação mecânica invasiva (30.4%), fármacos inotrópicos e/ou vasopressores (15.7%), diálise (4.9%) ou ventilação não invasiva (4.9%). Entre as doentes com doença hipertensiva da gravidez, a necessidade de ventilação mecânica invasiva (B=10.09, t=3.92, p=0.017) e os valores de GGT (gama-glutamil transferase) à admissão (B=0.035, t=3.23, p=0.032) foram fatores preditores independentes do tempo de internamento. Não se observaram mortes maternas e houve 20 mortes fetais ou neonatais (20%). Conclusão: A doença hipertensiva da gravidez e a hemorragia pós-parto foram as principais causas de admissão em UCI. Observou-se uma elevada incidência de disfunção de órgão, principalmente com necessidade de ventilação mecânica invasiva, achado que é consistente com outros estudos.
Introduction: Maternal mortality has declined significantly over the past few decades, particularly in developed countries. Pregnant and postpartum women rarely require intensive care unit (ICU) admission. There are few studies regarding the morbimortality in obstetric critical illness. The aim of this study was to assess the most common obstetric-related conditions that require ICU admission. Methods: This was an observational retrospective cohort study of all pregnant and postpartum women admitted to an ICU of a tertiary university hospital between January 2012 and January 2023. Data was collected from electronic files. Results: 102 ICU admissions relating to 100 patients were included. 89 (87.3%) were postpartum women and 13 (12.7%) were pregnant. Mean age was 33±6.6 years. 38 (37.3%) patients had two or more causes of ICU admission and the most common were hypertensive disorders of pregnancy (HDP) (49%), postpartum hemorrhage (45.1%) and infection (18.6%). The most common complications were acute kidney injury (26.5%) and respiratory failure (23.5%). About 55% of the admissions required organ support therapy such as blood products (40.2%), invasive mechanical ventilation (IMV) (30.4%), inotropes and/or vasopressors (15.7%), dialysis (4.9%) or non-invasive ventilation (4.9%). Among HDP patients, the need for IMV (B=10.09, t=3.92, p=0.017) and Gammaglutamyl transferase (GGT) values at admission (B=0.035, t=3.23, p=0.032) were independent predictors of length of stay. We observed no maternal deaths and 20 fetal or neonatal deaths (20%). Conclusion: HDP and postpartum hemorrhage were the leading causes of ICU admission. We observed a high rate of organ dysfunction, mainly IMV requirement, which is consistent with other studies.
Introduction: Maternal mortality has declined significantly over the past few decades, particularly in developed countries. Pregnant and postpartum women rarely require intensive care unit (ICU) admission. There are few studies regarding the morbimortality in obstetric critical illness. The aim of this study was to assess the most common obstetric-related conditions that require ICU admission. Methods: This was an observational retrospective cohort study of all pregnant and postpartum women admitted to an ICU of a tertiary university hospital between January 2012 and January 2023. Data was collected from electronic files. Results: 102 ICU admissions relating to 100 patients were included. 89 (87.3%) were postpartum women and 13 (12.7%) were pregnant. Mean age was 33±6.6 years. 38 (37.3%) patients had two or more causes of ICU admission and the most common were hypertensive disorders of pregnancy (HDP) (49%), postpartum hemorrhage (45.1%) and infection (18.6%). The most common complications were acute kidney injury (26.5%) and respiratory failure (23.5%). About 55% of the admissions required organ support therapy such as blood products (40.2%), invasive mechanical ventilation (IMV) (30.4%), inotropes and/or vasopressors (15.7%), dialysis (4.9%) or non-invasive ventilation (4.9%). Among HDP patients, the need for IMV (B=10.09, t=3.92, p=0.017) and Gammaglutamyl transferase (GGT) values at admission (B=0.035, t=3.23, p=0.032) were independent predictors of length of stay. We observed no maternal deaths and 20 fetal or neonatal deaths (20%). Conclusion: HDP and postpartum hemorrhage were the leading causes of ICU admission. We observed a high rate of organ dysfunction, mainly IMV requirement, which is consistent with other studies.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Complicações obstétricas Doença crítica Mortalidade materna