Clinical Analysis Of Obstetrics Combined With ICU In The Treatment Of Critically Ill Pregnant Women

Objective:This study aims to understand the disease details,treatment process,and etiology of critically ill pregnant women,analyze the reasons for their admission to the Intensive Care Unit(ICU),summarize the experiences gained from collaborative rescue efforts between obstetrics and ICU,and provide references for reducing mortality rates and improving prognosis.The goal is to enhance the diagnostic and rescue capabilities for this group of pregnant women in obstetrics.Methods:A retrospective analysis of clinical data from obstetric admissions of pregnant women at Tongji Hospital,Huazhong University of Science and Technology,Shenzhen,from June 2014 to June 2022 was conducted.Basic information,pregnancy status of critically ill pregnant women,disease details,and treatment information were collected.Results1.The main causes of admission to the ICU for critically ill pregnant women were as follows:(1)Pregnancy-induced hypertension and related complications accounted for 32.1%(53/165)of cases,with complications including HELLP syndrome and eclampsia.(2)Pregnancy complicated by heart disease accounted for 12.1%(20/165)of cases.(3)Postpartum hemorrhage accounted for 9.1%(15/165)of cases.2.Among the 165 critically ill pregnant women admitted to the ICU,they were divided into two groups based on the etiology of their diseases:the obstetric factors group and the non-obstetric factors group.The obstetric factors group comprised 108 cases(65.5%),while the non-obstetric factors group comprised 57 cases(34.5%).The etiology of critically ill pregnant women admitted to the ICU(obstetric factors group)included pregnancy-induced hypertension and related complications,placenta previa,and postpartum hemorrhage.The top three etiological factors in the non-obstetric factors group were pregnancy complicated by chronic hypertension,rheumatic immune diseases combined with pregnancy,and pregnancy complicated by heart disease.3.Compared to the non-obstetric factors group,the obstetric factors group showed a significantly higher prevalence in regular antenatal care,advanced maternal age,average length of ICU stay,full-term deliveries,and deliveries between 28-37 weeks of gestation(P<0.05).Conversely,the non-obstetric factors group had a significantly higher number of preterm deliveries(less than 28 weeks of gestation)than the obstetric factors group(P<0.05).Comparative analysis of delivery information between the two groups revealed that the obstetric factors group had a significantly higher volume of postpartum red blood cell transfusion and intraoperative bleeding within 1 day(P<0.05).4.In the ICU,compared to the non-obstetric factors group(5 cases),the obstetric factors group had a significantly higher number of cases with deep venous catheterization(14 cases)(P<0.05).Conversely,the non-obstetric factors group showed a significantly higher number of cases requiring invasive mechanical ventilation compared to the obstetric factors group(P<0.05).5.Among the 165 critically ill pregnant women transferred to the ICU for treatment,125 cases were discharged successfully,including 97 cases in the obstetric factors group and 28 cases in the non-obstetric factors group,showing a significant difference between the two groups(P<0.05).Among the patients transferred for continued treatment,there were 8 cases in the obstetric factors group and 26 cases in the non-obstetric factors group,indicating a significant difference between the two groups(P<0.05).6,Among the critically ill pregnant women transferred to the ICU,pulmonary embolism during pregnancy,amniotic fluid embolism,and pregnancy-related acute fatty liver were the top three diseases with the longest average length of stay.7.Among the 165 pregnant women admitted to the ICU,there were 132 live births,including 87 cases in the obstetric factors group and 45 cases in the non-obstetric factors group.Significant differences were observed in cases of intrauterine fetal death,full-term deliveries,and neonatal mortality between the two groups,with the obstetric factors group being significantly higher(P<0.05).In terms of cases of miscarriage,the non-obstetric factors group had a significantly higher number than the obstetric factors group(P<0.05).There was no significant difference observed between the two groups regarding full-term deliveries(P>0.05).Conclusion:1.This study indicates that the risk factors leading to the admission of critically ill pregnant women to the ICU mainly include obstetric and non-obstetric complications,irregular antenatal care,cesarean section,age,and obstetric complications.The primary obstetric factors include postpartum hemorrhage,pregnancy complicated by heart disease,and pregnancy-induced hypertension.However,circulatory failure and respiratory failure can be independent fatal factors for critically ill pregnant women.2.Obstetric causes are the main factors leading to maternal death among critically ill pregnant women,with pregnancy-induced hypertension-related complications being the primary cause.Prematurity is the leading cause of neonatal mortality.