Authors:

Luke C, Walsh A, Shanley E, O’ Riain S, Barrett N, Doody K, Nix CM
Anaesthesiology department, University Hospital Limerick

Title:

A retrospective review of non-obstetric surgical admissions of maternity patients to the critical care unit at a tertiary general hospital over a five year period

Background:

Around 1% of maternity patients may require non-obstetric surgery during their pregnancy.
Providing anaesthesia and surgery for these patients presents additional challenges for both mother and baby, however, surgical outcomes are generally considered favourable. Common indications not-related to pregnancy include acute appendicitis and acute cholecystitis (1:2,000 and 6:1,000 pregnancies respectively), maternal trauma and surgery for maternal malignancy¹. These authors wanted to review the non-obstetric surgical maternity cases which presented to our large tertiary general hospital over a five year period from a cohort of 20,147 maternities.

Methods:

Ethical approval was sought from the region’s ethics committee. A list of obstetric admissions to the critical care unit [CCU] (high dependency [HDU] and intensive care units [ICU]) was generated using a combination of the ICU clinical information system and handwritten HDU ledgers. Charts were then requested for review via the administration department.

Results:

From 2019-2023 inclusive, four women were admitted to the ICU and four women were admitted to the HDU with non-obstetric surgical conditions (0.04% of all maternity patients for the same five year period) which amounts to 10% of all maternity admissions to the critical care unit [ 8/81]). One patient received care in both HDU and ICU. Causes of admission were varied, ranging from an unstable upper GI bleed^x2, small bowel obstruction^x2, necrotising fasciitis, exacerbation of ulcerative colitis, abdominal pain. The majority (71.4%) of these patients were antepartum [5/7], the mean gestational age was 20.2 weeks with a median gestational age of 16 weeks.

Conclusion:

Non-obstetric surgical presentations in the maternity population are uncommon but may require admission to critical care. Familiarity with maternity patients in the non-obstetric surgical setting is thus essential in providing adequate care to this cohort.

 

1.         Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. British Journal of Anaesthesia. 2011;107:i72-i8.