Critical illness during pregnancy and the peripartum period
- Peter F Clardy, MD
Peter F Clardy, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Christine C Reardon, MD
Christine C Reardon, MD
- Associate Professor of Medicine
- Boston University School of Medicine
- Section Editors
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- David L Hepner, MD
David L Hepner, MD
- Section Editor — Obstetric Anesthesia
- Associate Professor of Anaesthesia
- Harvard Medical School
Although fewer than 2 percent of women require admission to an intensive care unit (ICU) during pregnancy or the peripartum period (the last month of gestation and the first few weeks after delivery), both maternal and fetal mortality are high when such care is required [1-8].
The disorders that are most common among women admitted to the ICU during pregnancy or the peripartum period are reviewed here. Issues related to acute respiratory failure during pregnancy and the peripartum period are discussed separately. (See "Acute respiratory failure during pregnancy and the peripartum period".)
INCIDENCE AND MORTALITY
The incidence of ICU admission for pregnant and postpartum women ranges from 0.7 to 13.5 per 1000 deliveries [2,9,10]. The most common indications for ICU admission are postpartum hemorrhage and the hypertensive disorders (severe preeclampsia or eclampsia) . However, all medical conditions that can complicate pregnancy can be encountered in the ICU.
Maternal mortality is high when critical care is required, with estimates ranging from 3.4 to 14 percent [8,11]. In the United States, the leading cause of maternal mortality is death due to cardiovascular disease and cardiomyopathy, which may relate to rising maternal age and high incidence of obesity, diabetes, and hypertension [8,12]. Other common causes of pregnancy-related mortality include venous thromboembolic disease, hemorrhage, infection, and amniotic fluid embolism. In one observational study, as many as 18 percent of maternal deaths were considered preventable . Causes of preventable maternal death included postpartum hemorrhage, preeclampsia, medication errors, and some infections. (See "Overview of maternal mortality and morbidity".)
Fetal mortality is also high when critical care is required [2,14-16]. Early gestational age, severe maternal illness, maternal shock, the need for maternal blood transfusions, and the absence of prenatal care are associated with fetal mortality.
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- INCIDENCE AND MORTALITY
- MANAGEMENT OF SPECIFIC DISEASES
- Cardiovascular disease
- Venous thromboembolism
- Preeclampsia or eclampsia
- Acute respiratory failure
- Liver disease
- TTP and HUS
- Posterior reversible encephalopathy syndrome
- Diabetic ketoacidosis
- SUPPORTIVE CARE
- Mechanical ventilation
- SUMMARY AND RECOMMENDATIONS