Evaluation of critically ill obstetric patients treated in an intensive care unit during the COVID-19 pandemic

Abstract

BACKGROUND: Although obstetric morbidity and mortality have decreased recently, rates are still high enough to constitute a significant health problem. With the COVID-19 pandemic, many obstetric patients have required treatment in intensive care units (ICU). OBJECTIVES: Evaluate critical obstetric patients who were treated in an ICU for COVID-19 and followed up for 90 days. DESIGN: Medical record review SETTING: Intensıve care unit PATİENTS AND METHODS: Obstetric patients admitted to the ICU between 15 March 2020 and 15 March 2022 and followed up for at least 90 days were evaluated retrospectively. Patients with and without COVID-19 were compared by gestational week, indications, comorbidities, length of stay in the hospital and ICU, requirement for mechanical ventilation, blood transfusion, renal replacement therapy (RRT), plasmapheresis, ICU scores, and mortality. MAIN OUTCOME MEASURES: Clinical outcomes and mortality. SAMPLE SIZE AND CHARACTERISTICS: 102 patients with a mean (SD) maternal age of 29.1 (6.3) years, and median (IQR) length of gestation of 35.0 (7.8) weeks. RESULTS: About 30% (n=31) of the patients were positive for COVID-19. Most (87.2%) were cesarean deliveries; 4.9% vaginal (8.7% did not deliver). COVID-19, eclampsia/preeclampsia, and postpartum hemorrhage were the most common ICU indications. While the 28-day mortality was 19.3% (n=6) in the COVID-19 group, it was 1.4% (n=1) in the non-COVID-19 group ( P <.001). The gestational period was significantly shorter in the COVID-19 group ( P =.01) while the duration of stay in ICU ( P <.001) and mechanical ventilation ( P =.03), lactate ( P =.002), blood transfusions ( P =.001), plasmapheresis requirements ( P =.02), and 28-day mortality were significantly higher ( P <.001). APACHE-2 scores ( P =.007), duration of stay in ICU ( P <.001) and mechanical ventilation ( P <.001), RRT ( P =.007), and plasmapheresis requirements ( P =.005) were significantly higher in patients who died than in those who were discharged. CONCLUSION: The most common indication for ICU admission was COVID-19. The APACHE-2 scoring was helpful in predicting mortality. We think multicenter studies with larger sample sizes are needed for COVID-19 obstetric patients. In addition to greater mortality and morbidity, the infection may affect newborn outcomes by causing premature birth. LIMITATIONS: Retrospectıve, single-center, small population size. CONFLICT OF INTEREST: None.