INTRODUCTION: Most obstetric patients admitted to intensive care units (ICU) present life-threatening complications of pregnancy, delivery, and postpartum, often leading to multiple organ failure (MOF), considered the main cause of death in ICUs. Although maternal mortality is an important indicator of health status in women and nations, few studies have analyzed MOF in obstetric ICU patients. The Sequential Organ Failure Assessment (SOFA) scale is a prognostic tool for ranking organ dysfunction in critically ill patients and correlating scores with outcome.

OBJECTIVE: Characterize obstetric patients diagnosed with MOF in the ICU of the Enrique Cabrera General Teaching Hospital, Havana, Cuba, between January 1, 1998 and December 31, 2006.

METHODS: A descriptive observational study was conducted of obstetric patients admitted to the ICU for >24 hours during the study period and diagnosed with MOF. Of 422 obstetric patients admitted, 58 met inclusion criteria. Patients’ clinical characteristics, chronic diseases, diagnoses, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, SOFA scores and discharge status were recorded in a data collection form. Day 1, Day 3, and maximum APACHE II and SOFA scores were calculated, and 3 prognostic groups were formed based on the difference between SOFA Day 1 and Day 3 scores (SOFAd 3−1: <0, clinical improvement; =0, no change; >0, poor prognosis). Data was entered in an EXCEL database and processed using SPSS 13.0 software. Quantitative variables were described by mean and standard deviation; qualitative variables by totals and percentages. A chi-square test was used to analyze associations between these variables and discharge status (alive or deceased) with significance level p <0.05.

RESULTS: Mortality from MOF in the study sample was 50.0%. More patients died in the 30–34 year age group (9/16, 56.3%), but mortality was highest in the 15–19 year age group (5/6, 83.3%) and was significantly associated with presence of preexisting chronic diseases (63.3% mortality in those patients). Postpartum hemorrhage was the most frequent obstetric condition (32.8% of cases), followed by preeclampsia (8.6%). Sickle cell anemia was the most frequent non-obstetric condition (15.5% of cases), followed by acute peritonitis (12.1% of cases). A <0 SOFAd 3−1 score correlated with a favorable prognosis (5.6% mortality) and a >0 score with an unfavorable prognosis (84.0% mortality). Respiratory and cardiovascular systems were the most affected (75.9% each).

CONCLUSIONS: Further studies analyzing MOF in obstetric patients are urgently needed in order to adopt more effective strategies for reducing maternal mortality in Cuba.

Keywords Multiple organ failure, multiple organ dysfunction syndrome, MODS, maternal mortality, intensive care, critical care, APACHE, pregnancy complications

Introduction In recent years, several reports have appeared in the international literature concerning evolution and prognosis for obstetric patients whose illnesses have led to admission to intensive care units (ICUs). The term severe maternal morbidity has been proposed to refer to life-threatening complications that occur during pregnancy, delivery or postpartum.

Objective Characterize severe maternal morbidity in obstetric patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana from 1998 to 2004.

Methods From 1998 to 2004, we conducted a prospective, descriptive, and observational study of 312 patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana, Cuba. Patients were included whose length of stay was >24 hours, and whose family members provided written informed consent. A data collection form was developed to record general characteristics, personal and family medical history, cause of ICU admission, diagnosis, obstetric condition at the onset of illness and at admission, pregnancy outcome, surgeries performed and patient’s ICU discharge status (survivor or non-survivor), the latter a dependent variable. An Excel database was compiled and processed using SPSS 13.0. Percentages were used to summarize qualitative variables. A Chi-square test was used for univariate analysis between these qualitative variables and patient discharge status; t-test was used for quantitative analyses.

Results Overall mortality in the cohort was 7.4% (23 patients), greater among women aged <20 years, those with a history of previous illnesses, and those subjected to several surgical interventions. Obstetric hemorrhage, pre-eclampsia/eclampsia, and postpartum sepsis were the most commonly diagnosed obstetric disorders. Non-obstetric disorders diagnosed included severe asthma, pneumonia and peritonitis. Amniotic fluid embolism, postpartum sepsis, early postpartum hemorrhage and pre-eclampsia/eclampsia were associated with the highest hospital case fatality rates in women with obstetric disorders; while acute chest syndrome, promyelocytic leukemia and pulmonary embolism were associated with the highest hospital case fatality rates among women with non-obstetric disorders.

Conclusions Our results concur with most of those published on severe maternal morbidity in ICUs, including a high incidence of hemorrhagic disorders, pre-eclampsia and postpartum sepsis. The number of patients with hematological disorders accounts for the difference between the results of our study and others concerning morbidity and mortality among this patient group. A significant correlation was observed between history of previous illnesses and patient discharge status. Prognosis was worse for patients subjected to several surgical interventions, which can be attributed to the higher risk of complications and the severity of the underlying illness.

Keywords Maternal mortality, maternal morbidity, intensive care, critical care, postpartum hemorrhage, pre-eclampsia, eclampsia, postpartum sepsis