Title: Obstetric patients requiring admission to a high-dependency unit in a Tertiary Maternity Hospital, a retrospective analysis

Introduction: There are a lack of granular data on the proportion of obstetric patients requiring HDU admission in Ireland. Accurate data on the rates of HDU admissions may be useful to guide the development of obstetric critical care services. (1)

Objective: To define the proportion of obstetric patients requiring HDU admission over a 12 month period in a large maternity centre in Ireland.

Methods: Booking forms for the HDU were retrieved from the admission folder for the 12 month period of 2022. Patient details were gathered from these booking forms and from the online electronic health record. These data were inputted into an excel sheet and analysed.

 

Results: Overall, 6,815 patients gave birth in 2022 and were included in the current analysis. Of these, 131 patients (2.0%) required HDU admission, with 4 of these patients requiring repeat HDU admission. The mean age of the patients admitted to HDU was 34.5 ± 5.8 years. The most common indications for HDU admission were haemorrhage (50.4%) and pre-eclampsia (18.3%). The mean blood loss in patients requiring HDU admission for haemorrhage was 2,205ml. Of the 66 haemorrhages resulting in HDU admission, 6 were classified as early pregnancy haemorrhages (<20 weeks). The indications for HDU admission are summarised in Table 1. There were no inpatient deaths in the HDU population in 2022.

Conclusion: A minority (2%) of obstetric patients in our centre required HDU admission. The majority of HDU admissions were due to haemorrhage.

 

Table 1. Indications for HDU admission in 2022

 

Indication for HDU admission	n (%)
Total	131 (100%)
Haemorrhage	66 (50.4%)
Pre-eclampsia	24 (18.3%)
Sepsis	8 (6.1%)
Cardiac conditions	6 (4.6%)
Metabolic/Endocrine disorders	6 (4.6%)
Neurological disorders	4 (3%)
Hypertension	3 (2.3%)
Anaphylaxis	2 (1.5%)
Disseminated intravascular coagulation	2 (1.5%)
Hypoxia/Respiratory disorders	1 (0.8%)
Miscellaneous	9 (6.9%)

 

 

1.         MBRACE. Saving Lives Improving Mothers’ Care 2023: Lay Summary. MBRACE-UK_Maternal Report. 2023.