Obstetric Patients in Intensive Care Unit

Öz

Objectives: We analyzed retrospectively all obstetric admission to determine the causes and outcomes of intensive care unit. Materials and Methods: In this study; 18 obstetric patient referred to ICU from 1999 to 2005 in pregnancy and/or postpartum period, were evaluated by observing demographic data, admittance reasons, interventions in ICU and clinical outcomes. Results: Incidence of obstetric cases in ICU was obtained as 2.7%. 13 cases (72.2%) were delivered from other hospitals. ICU requirement rate is 1 per 421 deliveries. Mean age of 18 patients is 27.4±5.4 years. ICU stay is 4.6 days and median APACHE II score is 7. There were differences APACHE II score between survivors and non-survivors (p

Anahtar Kelimeler

• -

Yoğun Bakım Ünitesinde Obstetrik Olgular

Öz

Amaç: Bu çalışmanın amacı Yoğun bakım ünitesine (YBÜ)'ne alınan obstetrik olguları retrospektif olarak değerlendirmek, YBÜ'ne kabul sıklığını, nedenlerini ve klinik sonuçlarını araştırmaktır. Gereç ve Yöntem: Yoğun bakım ünitesine (YBÜ) 1999-2005 yılları arasında gebe ve/veya postpartum dönemde yatırılan 18 obstetrik olgunun retrospektif demografik verileri, kabul nedenleri, yoğun bakımda yapılan girişimleri ve klinik sonuçları incelenerek değerlendirilmeye alındı. Bulgular: Obstetrik olguların YBÜ'ndeki sıklığı %2.7 olarak bulundu. 13 olgu (%72.2) diğer hastanelerden sevk edilmiştir. Yoğun bakım kullanma oranımız 421 doğumda 1'dir. 18 olgunun ortalama yaşı 27.4±5.4'tür. Yatış süreleri 4.6 gün ve APACHE II skoru orta değeri 7'dir. Yaşayan ile yaşamayan olgular arasında APACHE II skorları farklı bulundu (p

Anahtar Kelimeler

• Gebelik, preeklampsi, eklampsi, postpartum hemoraji, yoğun bakım ünitesi

Kaynakça

1. Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in United States, 1987-1990. Obstet Gynecol 1996; 88:161-7.
2. Panchal S, Arria AM, Haris AP. Intensive care utilization during hospital admission for delivery. Prevalence, risk factors, and outcomes in a statewide population. Anesthesiology 2000; 92:1537-44.
3. Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol 1998; 105:981-4.
4. Tripathi R, Rathore AM, Saran S. Intensive care for critically ill obstetric patients. Int J Gynaecol Obstet 2000; 68: 257-8.
5. Mahutte NG, Murphy-Kaulbeck L, Le Q, Solomon J, Benjamin A, Boyd ME. Obstetric admissions to the intensive care unit. Obstet Gynecol 1999; 94: 263-6.
6. Atrash HK, Koonin LM, Lawson HW, Franks AL, Smith JC. Maternal mortality in the United States, 1976-1986. Obstet Gynecol 1990; 76: 1055-60.
7. T.C. Sağlık Bakanlığı. (2005) Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü. Ana ve Çocuk Ölümlerini Önleme Projesi. Web sayfası: http://www.saglik.gov.tr
8. Yanık FF, Malatyalıoğlu E, Koçak İ, Yanık A, Bolat İ, Kökçü A. Analysis of the pregnancy-related deaths within the last two decades: a university hospital-based study from Turkey. Eur J Obstet Gynecol Reprod Biol 1999; 87: 143-5.

9. Demirkiran O, Dikmen Y, Utku T, Urkmez S. Critically ill obstetric patients in the intensive care unit. International Journal of Obstetric Anesthesia 2003; 12: 266-70
10. Graham SG, Luxton MC. The requirement for intensive care support for pregnant population. Anaesthesia 1989; 44: 581-4.
11. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13: 818-29.
12. Karnad DR, Lapsia V, Krishnan A, Salvi VS. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med 2004; 32: 1294-9.
13. El-Solh AA, Grant BJ. A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest 1996; 110: 1299-304.
14. Lapinsky SE, Kruczynski K, Seaward GR, Farine D, Grossman RF. Critical care management of the obstetric patient. Can J Anaesth 1997; 44: 325-9.
15. Bhagwanjee s, Paruk F, Moodley J, Muckart DJ. Intensive care unit morbidity and mortality from eclampsia:an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score. Crit Care Med 2000; 28: 120-4.
16. Cohen J, Singer P, Kogan A, Hod M, Bar J. Course and outcome of obstetric patients in a general intensive care unit. Acta Obstet Gynecol Scand 2000; 79: 846-50.
17. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 2001; 322: 1089-94.
18. Collop NA, Sahn SA. Critical illness in pregnancy. An analysis of 20 patients admitted to a medical intensive care unit. Chest 1993; 103: 1548-52.
19. Nolan TE, Wakefield M, Devoe LD. Invasive hemodynamic monitoring in obstetrics. A critical review of its indications, benefits, complications, and alternatives. Chest 1992; 101: 1429- 33.
20. Mabie WC, Barton JR, Sibai BM. Adult respiratory distress syndrome in pregnancy. Am J Obstet Gynecol 1992; 167: 950-7.
21. Mabie WC, Sibai BM. Treatment in an obstetric intensive care unit. Am J Obstet Gynecol 1990; 162: 1-4.
22. Kabul Tarihi: 05.01.2006