OS024. Characteristics and outcomes of critically ill obstetric patientswith hypertensive disease of pregnancy in argentina: Multicenter study

D N Vasquez; A V Das Neves; G Zakalik; D Intile; F Cicora; M Casanova; H S Canales; V Aphalo; C Loudet; A Sanchez; P Desmery; E Estenssoro

doi:10.1016/j.preghy.2012.04.025

OS024. Characteristics and outcomes of critically ill obstetric patientswith hypertensive disease of pregnancy in argentina: Multicenter study

Pregnancy Hypertens. 2012 Jul;2(3):188-9. doi: 10.1016/j.preghy.2012.04.025. Epub 2012 Jun 13.

Authors

D N Vasquez¹, A V Das Neves², G Zakalik³, D Intile⁴, F Cicora⁵, M Casanova⁴, H S Canales⁶, V Aphalo⁴, C Loudet⁶, A Sanchez³, P Desmery⁴, E Estenssoro⁶

Affiliations

¹ Intensive Care Unit, HIGA Gral San Martin, La PLata, La Plata, Argentina; Intensive Care Unit, Sanatorio Anchorena, CABA, Argentina; Fundacion para la Investigacion y Asistencia de la Enfermedad Renal (FINAER), La Plata, Argentina.
² Intensive Care Unit, HIGA Gral San Martin, La PLata, La Plata, Argentina; Intensive Care Unit, Fundacion para la Investigacion y Asistencia de la Enfermedad Renal (FINAER), La Plata, Argentina.
³ Intensive Care Unit, Hospital Lagomaggiore, Mendoza, Argentina.
⁴ Intensive Care Unit, Sanatorio Anchorena, CABA, Argentina.
⁵ Fundacion para la Investigacion y Asistencia de la Enfermedad Renal (FINAER), La Plata, Argentina.
⁶ Intensive Care Unit, HIGA Gral San Martin, La PLata, La Plata, Argentina.

PMID: 26105238
DOI: 10.1016/j.preghy.2012.04.025

Abstract

Introduction: Worldwide, hypertensive disease of pregnancy is one of the most frequent causes of admission of obstetric patients to the ICU. Maternal mortality risk related to Hypertension during pregnancy in Latin America is significantly higher than in developed countries.

Objectives: To describe the characteristics and outcomes of pregnant-postpartum patients with hypertensive disease of pregnancy admitted to ICU METHODS:

Design: Multicenter case series study.

Population: pregnant-postpartum (<42days) patients with hypertensive disease of pregnancy admitted to ICU.

Setting: 3 ICUs in Argentina, 2 from the Public (P1) and 1 from the Private Health Sector (P2).

Statistics: Continuous data are presented as mean±SD or median [IQR], and categorical data as number (%). Comparisons among continuous data were performed with unpaired t test or Mann-Whitney U test. Categorical variables were analyzed by Chi-square test or Fisher exact test as appropriate. A two-sided α<0.05 was considered as significant. SPSS version 15 was used.

Results: One hundred and eighty four patients were included, 161(87.5%) from P1. General characteristics are shown in the Table. Gestational age was 34±5 weeks. Risk factors for preeclampsia not included in Charlson score were chronic hypertension (22;12%), Obesity (6;3%) and preeclampsia in previous pregnancy (5;3%). ICU admission was postpartum in 80%(145). Causes of admission were eclampsia (63;34%), severe preeclampsia (61;33%), HELLP (33;18%), Eclampsia-HELLP (18;10%), Chronic Hypertension (5;3%) and Gestational Hypertension (4;2%). Predictive mortality according with APACHEII was 14%. Antenatal care was present in 115/142(81%) patients; 97/124(78%) in P1 vs 18/18 (100%) in P2; p0.024. Antenatal care was appropriate in 77/108(71.3%) of patients; 59/90(65.5%) in P1 vs 18/18(100%) in P2; p0.001. Maternal deaths (6) occurred in the Public sector and none of the patients had received antenatal care. Causes of mortality were hemorrhagic stroke (3) and multiple organ dysfunction (3) Table 1.

Conclusion: Most patients were from the public health sector and the majority did not have any comorbidity according with the Charlson score. Nevertheless, 18% presented risk factors for preeclampsia, not included in the mentioned score. Two-thirds of patients were admitted with eclampsia and severe preeclampsia. APACHEII overpredicted mortality. Half of deaths were related with hemorrhagic stroke, complication almost eradicated from developed countries. None of the patients who died had received antenatal care.