Analysis Of Clinical Characteristics Of 136 Severe Maternal Cases

Objective:To analyze the clinical data and perinatal outcomes of severe maternal cases,and to explore the high-risk factors for their admission to intensive care unit,so as to provide clinical basis for early identification and early intervention.Methods:A total of 136 severe maternal cases were included in the Department of Obstetrics and Intensive Care Unit(ICU),affiliated of Southeast University.from January 2016 to November2019.According to whether admitted to ICU,they are divided into two groups: ICU group(n=76)and non-ICU group(n=60).The clinical data including demographic characteristics,main cause,pregnancy-labor history,delivery pregnancy week,maternal and child outcomes,clinical management,hospitalization costs,and length of stay were collected.The SPSS 21.0 statistical software was used to analyze the data.Results:1 A total of 136 severe maternal cases were included in this study,and the ICU admission rate was 55.88%.In the ICU group,2 patients died after giving up treatment and leaving the hospital,while the rest of severe maternal cases survived,with a mortality rate of 1.47%.There were statistically significant differences in residence,referral between between ICU group(n=76)and non-ICU group(P<0.05).But there were no statistically significant differences in age,education background,body mass index,regular labor tests,pregnancy times and labor times between ICU group and non-ICU group(P>0.05).2 In a descending order,postpartum hemorrhage,hypertensive disorders complicating pregnancy,and heart disease,sepsis are the primary diagnoses among severe maternal cases.In the ICU group,the first four diseases are postpartum hemorrhage,hypertensive disorders complicating pregnancy,heart disease and sepsis.In the non-ICU group,the first four diseases are postpartum hemorrhage,hypertensive disorders complicating pregnancy,hematological diseases complicating pregnancy and sepsis.There are statistically significant differences in the incidence of heart disease between ICU group and non-ICU group(P < 0.05).3.The cesarean section rate was 75.74%(103/136),abortion rate was 15.44%(21/136)and preterm birth rate was 41.91%(57/136).There are statistically significant differences in the cesarean section rate and incidence of stillbirth between ICU group and non-ICU group(P<0.05).There are no statistically significant differences in the 1st min Apgar score,5th min Apgar score,and NICU transfer between between ICU group and non-ICU group(P>0.05)4 The averaged APACHE II score of ICU group is 12.32±0.80,with an estimated mortality rate is 17.25%.Median SOFA score is 4.0(2.0,7.0).In the ICU group,21 patients(21/76)developed multi-organ dysfunction syndrome,and the most common organ/system with firstepisode dysfunction is the circulatory system(38/76).The most frequently used specific clinical intervention was endotracheal intubation(43/76).Binary Logistic regression analysis shows that cesarean section and pregnancy complications are independent risk factors for ICU admission of severe maternal cases(P < 0.05).5 There is statistically significant difference in hospitalization expenses and length of stay between between ICU group and non-ICU group(P < 0.05).There was no statistically significant between referral and non-referral,rural areas and urban areas(P > 0.05).Conclusion:1 Severe maternal cases who come from rural areas and referred are more likely to be admitted to the ICU.2.The main causes of severe maternal cases are mainly obstetric factors,mainly postpartum hemorrhage and hypertensive diseases during pregnancy.Among the nonobstetric factors,the incidence of pregnancy complicated with heart disease is the highest.Severe maternal cases with heart disease is more likely to be transferred to ICU3.Cesarean section is the main delivery method for severe maternal cases.Compared with non-ICU group,cesarean section rate and incidence are higher in ICU group.4 APACHE II score overestimate predicts the mortality of severe maternal cases who admitted to ICU.SOFA score can help judge the function of each organ and understand the severity of the disease.Severe maternal cases who admitted to ICU are prone to multi-organ dysfunction,which requires close monitoring of hemodynamics and invasive monitoring if necessary.Cesarean section and pregnancy complications are high risk factors for severe maternal cases admitted to ICU.