Análise do perfil epidemiológico, sobrevida e fatores de prognóstico materno de pacientes admitidas em uma Unidade de Terapia Intensiva obstétrica

Abstract

Purpose: This study describes a based population investigation on severe acute maternal morbidity, near-miss, and maternal mortality in an obstetric intensive care unit (ICU) in Brazil. The analysis aims to identify the epidemiologic profile, the maternal survival and factors that may influence survival in obstetric ICU. Methods: Analysis of demographic, diagnostic and outcomes until ICU discharge or death, from January 2007 to March 2009 were conducted. Mortality was related with the reason of ICU admission: direct obstetric, indirect-obstetric or non-obstetric causes, according World Health Organization definitions. The group of reasons for admissions had their impact on maternal survival evaluated by Kaplan Meier curves and Log-rank test. Results: In atotal of 299 admissions in ICU, the mortality rate was 4.7%. The main cause of admission on ICU was hypertension (54.2%), followed by hemorrhage (19.1%), sepsis (13.4%), maternal cardiopathies (5.4%) and others (8%). The medium APACHE II score at admission was 9.8. Half of the patients who died were admitted in ICU for an obstetric reason. Twenty five percent of all patients required mechanical ventilation andonly 5% needed hemodialysis. The medium length of stay was five days. The maternal survival for the group of patients who were admitted in ICU due non-obstetric reason was lower (median 13 days) than those admitted for direct obstetric (median 27.8 days) or indirect-obstetric reasons (median 21.5 days, Log-rank, p=0.001). ICU survival ratewas statistically associated with the diagnostic group by the admission (p <0.001), with major of the surviving cases admitted by direct obstetric causes (75.4%). Conclusions: Obstetric direct causes accounts for three-fourth of all cases of ICU admission. The main cause of admission in the obstetric ICU was hypertensive disorders, but the lower time of survival was found in the group of admission causes not directly related to pregnancy.