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Characteristics and preventability of obstetric intensive care unit admissions in Far North Queensland
Author(s) -
Jayaratnam Skandarupan,
JacobRodgers Sebastian,
Costa Caroline
Publication year - 2020
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13198
Subject(s) - medicine , near miss , audit , observational study , intensive care unit , pregnancy , maternal morbidity , epidemiology , emergency medicine , retrospective cohort study , intensive care , pediatrics , medical emergency , intensive care medicine , forensic engineering , management , pathology , biology , engineering , economics , genetics
Background The rarity of maternal deaths in developed countries has increased interest in auditing cases of severe maternal morbidity or maternal ‘near miss’. The assessment and preventability of cases of maternal ‘near misses’ are important in improving the provision of maternity care. Aims To describe the epidemiology and determine aspects of preventability in care among women admitted to an obstetric intensive care unit (ICU) in Far North Queensland. Materials and Methods A retrospective observational study of pregnant and postpartum patients admitted to the Cairns Hospital ICU between 1 January 2013 and 31 December 2017 was undertaken. Cases of severe maternal morbidity were identified using the World Health Organization (WHO) ‘near miss’ criteria and reviewed to determine reasons for admission to ICU and ascertain aspects of preventability in the care provided. Results Sixty‐nine out of 12 081 (0.6%) women admitted for obstetric care were transferred to the ICU with 31 cases fulfilling WHO ‘near miss’ criteria. The most common direct obstetric‐related diagnosis for ICU admission was hypertensive disease of pregnancy and obstetric haemorrhage. Indirect obstetric causes contributed to approximately 40% of ICU admissions. Among the 31 cases of WHO ‘near miss’, ten cases were deemed preventable with the most common reason for preventability related to lack of recognition of high‐risk clinical status. Conclusion Maternal ‘near miss’ and rates of obstetric admission to the ICU at Cairns Hospital are reassuringly low. Nevertheless, one‐third of women with ‘near miss’ required improvements in the provision of care, emphasising the need for continued audit and improvement of clinical practice.