Author: Sean Hartigan, et al.
International Journal of Obstetric Anesthesia
This retrospective cohort study examined 11 years of obstetric critical care admissions at Galway University Hospital in Ireland. The investigators evaluated admission rates, causes of critical illness, organ-support requirements, length of stay, and changes in critical care practice from 2013 through 2023.
Study Design
The study included all pregnant and postpartum patients admitted to the hospital’s critical care unit during the 11-year period.
Researchers reviewed electronic critical care records and paper charts to collect information regarding:
- Maternal and obstetric characteristics
- Reason for critical care admission
- Level of care required
- Respiratory, cardiovascular, and renal support
- Acute kidney injury
- Critical care length of stay
- Maternal mortality
Admission incidence was calculated relative to the total number of maternal deliveries.
Key Findings
There were 207 obstetric critical care admissions, representing 6.7 admissions per 1,000 maternal deliveries.
The leading reasons for admission were:
- Sepsis: 37.2%
- Hemorrhage: 28.0%
The finding that sepsis was more common than hemorrhage contrasts with some previous Irish reports in which obstetric hemorrhage was the predominant reason for transfer or escalation of care.
Most patients required level 2 critical care rather than full intensive care:
- Level 2 care: 76.5%
- Respiratory support: 55.0%
- Vasopressor or inotropic support: 21.7%
- Renal replacement therapy: 1.4%
The average critical care stay was relatively brief at 1.9 days.
The overall obstetric critical care admission rate remained stable during the study period. However, vasopressor and inotropic use increased significantly over time.
Clinical Implications
Obstetric critical illness was uncommon in this tertiary referral center and generally required short-duration organ support.
The predominance of sepsis emphasizes the importance of:
- Early recognition of maternal infection
- Prompt antibiotic administration
- Hemodynamic assessment and resuscitation
- Clear escalation pathways between maternity and critical care services
- Multidisciplinary management involving obstetricians, anesthesiologists, intensivists, and maternal-fetal medicine specialists
The increasing use of vasopressors and inotropes may reflect changes in clinical practice, earlier recognition of cardiovascular instability, or a change in the severity and complexity of admitted patients.
Interpretation
Critical care admission rates should not be interpreted in isolation. Differences among institutions may reflect local maternity-unit configuration, availability of high-dependency care, referral patterns, and thresholds for critical care admission.
A hospital with integrated maternity and critical care services may admit patients earlier or manage conditions differently than hospitals that depend on maternal transfers to outside intensive care units.
Limitations
This was a retrospective, single-center study, which limits its generalizability to other hospitals and health systems.
The study also depended on the accuracy and completeness of electronic and paper medical records. Institutional changes in admission thresholds, documentation practices, or organ-support protocols may have influenced the observed temporal trends.
Conclusion
Obstetric critical care admission at this Irish tertiary referral center was uncommon and usually involved brief level 2 care.
Sepsis was the most frequent reason for admission, exceeding hemorrhage. Most patients required respiratory support, while approximately one in five required vasopressors or inotropes.
These findings demonstrate the importance of integrated maternity and critical care services and highlight sepsis recognition and treatment as major priorities in preventing severe maternal morbidity.
We thank the publishing journal for allowing us to summarize this important clinical research.