集中治療部で治療された産科患者の分析

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  • Analysis of obstetric patients treated in general intensive care unit.

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We retrospectively studied all obstetric patients admitted to the General Intensive Care Unit (ICU) of Kobe City General Hospital from 1985 to 1996. The aim of the study was to determine the incidence, causes and outcome of these admissions.<br>Forty cases were identified; the incidence was 0.17% of the total number of ICU admissions, and 0.3% with respect to the total number of deliveries during the same period. Of 40 cases, 19 (47.5%) were referred from other hospitals or physicians. All but one patient with bronchial asthma were admitted to the ICU postpartum. Obstetric complications accounted for 75% of admissions and preexisting medical problems accounted for the remaining 25%. Preeclampsia/eclampsia was the most frequent cause of obstetric complications, followed by postpartum hemorrhage and severe placental abruption.<br>Nineteen patients (47.5%) had one or more complications; pulmonary embolism in 2, pulmonary edema in 2, eclampsia in 4, acute renal failure in 8, HELLP (hemolysis, elevated liver enzyme, low platelet) syndrome in 2, pneumonia in 1 and disseminated intravascular coagulation in 10. Twenty-six of 40 patients (65%) including all the patients with postpartum hemorrhage and 8 with non-obstetric disorders were discharged from the ICU within 24 hours. Four patients stayed in the ICU over one week, and 10 patients stayed for 2 to 4 days. Most were related to preeclampsia/eclampsia. The transferred patients had more severe obstetric complications and stayed in the ICU longer than the inpatients from our facility.<br>This study reconfirmed that proper prenatal care is essential for reducing postpartum morbidity and that preeclampsia/eclampsia remains a significant complication with high morbidity.

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