Severe acute maternal morbidity, Obstetric complications, Maternal death, Confidential enquiries, Intensive care unit, Cork University Maternity Hospital
Background Severe acute maternal morbidity (SAMM) describes life threatening obstetric complications, and is used as an adjunct to maternal death confidential enquiries. Admission to the Intensive Care Unit (ICU) is commonly used as a marker for SAMM. CUMH is the only maternity hospital of its size in Ireland co-located with a large general hospital and ICU.
Aims We aimed to determine the rate of and indications for ICU admission in women from early pregnancy up to 6 weeks postpartum, and to examine the management of individual cases.
Methods We performed a retrospective review of obstetric patients requiring ICU admission from 2007–2013. Cases were identified from hospital and ICU registers, and individual charts reviewed to record demographics, reproductive and medical history, pregnancy complications, as well as details of the SAMM event.
Results Thirty-two women had 35 admissions to ICU during or after pregnancy. There was a disproportionate representation of women of non-Irish ethnicity (50% n = 17). The mean age of the population was 30.8 years. The primary diagnosis of women fell largely between major obstetric haemorrhage (44.1% n = 15), and Pre-eclampsia/ HELLP (29.4% n = 10) with other causes such as pneumonia, septic shock and pulmonary embolism making up the remaining admissions. There were 2 maternal deaths; both women had numerous risk factors and co-morbidities.
Conclusions Maternal deaths enquiries may not provide an accurate portrayal of maternal morbidity in the obstetric population. Using SAMM instead highlights the pregnancies most at risk and facilitates learning from management of these complex cases.