Obstetric and pregnancy-related critically ill patients admitted to a tertiary anesthesiology intensive care unit: A retrospective single-center cohort study

Aim: Critically ill obstetric patients may require advanced organ support, while pregnancy-related physiological changes can complicate illness-severity assessment. This study evaluated the clinical characteristics, treatment requirements, and outcomes of critically ill obstetric patients admitted to a tertiary anesthesiology intensive care unit and compared observed in-hospital mortality with Acute Physiology and Chronic Health Evaluation II (APACHE II)-predicted mortality.Methods: This retrospective, single-center cohort included pregnant patients and women admitted within 42 days after pregnancy termination between January 1, 2010, and December 31, 2018. Demographic and obstetric characteristics, admission diagnoses, severity scores, organ-support therapies, transfusions, intensive care unit length of stay, and hospital outcomes were reviewed. Six patients transferred with unknown final outcomes were excluded from mortality analyses. The standardized mortality ratio was calculated by dividing the observed number of deaths by the expected number of deaths derived from APACHE II-predicted mortality probabilities.Results: The cohort included 206 patients with a mean age of 29.00 ± 7.33 years, a median gestational age of 31.0 weeks, and a median APACHE II score of 8.0. Preeclampsia, eclampsia, or HELLP syndrome occurred in 130 patients (63.1%), and obstetric hemorrhage occurred in 76 (36.9%). Invasive mechanical ventilation was required in 187 patients (90.8%), blood-product transfusion in 108 (52.4%), vasoactive or inotropic support in 25 (12.1%), and continuous renal replacement therapy in 6 (2.9%). Among 200 patients with known outcomes, 26 died, yielding an in-hospital mortality rate of 13.0%. The mean APACHE II-predicted mortality was 15.77%, corresponding to 31.53 expected deaths, resulting in a standardized mortality ratio of 0.82 (95% confidence interval, 0.54–1.21).Conclusion: Observed mortality was lower than APACHE II-predicted mortality, although not significantly. APACHE II estimates should be interpreted alongside obstetric diagnoses, organ dysfunction, and organ-support requirements.