Critical care admissions and outcomes in pregnant and postpartum women: a systematic review

• Published in: Intensive care medicine 2024-12, Vol.50 (12), p.1983-1993
• Main Authors: Tripathy, Swagata, Singh, Neha, Panda, Aparajita, Nayak, Subhasish, Bodra, Nivedita Jayanti, Ahmad, Suma Rabab, Parida, Madhusmita, Sarkar, Monalisa, Sarkar, Soumya
• Format: Article
• Language: English
• Subjects: Adult; Anesthesiology; Best practice; Clinical outcomes; Critical care; Critical Care - standards; Critical Care - statistics & numerical data; Critical Care Medicine; Developed Countries - statistics & numerical data; Developing Countries - statistics & numerical data; Emergency Medicine; Female; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Intensive; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Maternal Mortality - trends; Medicine; Medicine & Public Health; Mortality; Pain Medicine; Patient Admission - statistics & numerical data; Pediatrics; Pneumology/Respiratory System; Postpartum; Postpartum Period; Pregnancy; Pregnancy complications; Pregnancy Complications - epidemiology; Pregnancy Complications - mortality; Pregnancy Complications - therapy; Regression analysis; Statistical analysis; Sustainable development; Systematic Review
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-024-07682-3

Purpose To synthesise evidence for the incidence of intensive care unit (ICU) admission, characteristics and mortality of pregnant and postpartum women with a focus on differences between high-income countries (HICs) and low-middle-income countries (LMICs) and report changes in reported findings since the last review by Pollock et al. (2010). Methods We searched Ovid Medline, EMBASE, and CINAHL (2010–2023), following best practice guidelines for abstract screening for large-evidence systematic reviews. Patient and study characteristics of extracted studies were analysed descriptively. Multivariable meta-regression analysis, employing mixed-effects models, was conducted for assessing ICU admission and mortality. Studies reviewed by Pollock et al. were included to perform an overall analysis, including each study period and geographic region in a model. Results Seventy-one eligible studies reported data on 111,601 women admitted to ICU, with 41,291,168 deliveries reported in 65 studies. Fifty-six studies were retrospective. Case definitions, admission criteria, and causes of mortality reported were heterogeneous. The pooled ICU admission rate was 1.6% (95% confidence interval [CI] 1.28–1.99; I 2  = 99.8%), 0.4% (95% CI 0.32–0.48, I 2  = 99.9%) in HICs versus 2.8% (95% CI 0.65–6.4, I 2  = 99.9%) in LMICs ( p