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Obstetrics & Gynecology 2003;102:897-903
© 2003 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Obstetric Admissions to the Intensive Care Unit: Outcomes and Severity of Illness

Tricia T. Gilbert, MD, John C. Smulian, MD, MPH, Andrew A. Martin, MD, Cande V. Ananth, PhD, MPH, William Scorza, MD and Anthony T. Scardella, MD for the Critical Care Obstetric Team*

From the Division of Pulmonary and Critical Care Medicine, Department of Medicine; Division of Maternal-Fetal Medicine and Section of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, New Jersey. ,*

Address reprint requests to: Anthony T. Scardella, MD, Saint Peter’s University Hospital, Division of Pulmonary and Critical Care Medicine, 254 Easton Avenue, New Brunswick, NJ 08901; E-mail: scardean{at}umdnj.edu.

OBJECTIVE: To determine whether mortality prediction based on a current model of outcome prediction is accurate in obstetric patients.

METHODS: Consecutive obstetric admissions to a medical intensive care unit from 1991 to 1998 were reviewed to determine whether mortality prediction is feasible in obstetric patients based on a widely used model. The Simplified Acute Physiologic Score (SAPS II) was used to predict the probability of hospital mortality.

RESULTS: The Simplified Acute Physiologic Score overestimated mortality in all patients (19 predicted deaths, eight observed) but accurately predicted mortality in patients admitted to the intensive care unit for medical reasons (seven predicted, five observed). The Simplified Acute Physiologic Score did not predict mortality in patients admitted for obstetric indications or postpartum hemorrhage. Median SAPS II scores were significantly higher in those patients who died, compared with survivors. For all groups, SAPS II scores were correlated with intensive care unit length of stay but not hospital length of stay.

CONCLUSION: The Simplified Acute Physiologic Score accurately predicts hospital mortality in obstetric patients admitted to the intensive care unit for medical reasons but not for indications related to pregnancy and delivery. An alternate model that predicts outcomes in obstetric patients admitted for obstetric indications should be developed.






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