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Critical Care Obstetrics (CCOB) Program Year One: Risk Stratification and Outcomes for Patients

who Received Care on Labor and Delivery (L&D) and Those Transferred to an Intensive Care

Unit (ICU)

James Conwell, DO;Ralph Alberto; Yael Sarig; Ashley Munoz RN; Jessica Morgan MD; Jean-Ju Sheen MD; and

Ruth Landau MD

Department of Anesthesiology, Columbia University Medical Center, New York

▪ From 2020-2022, the maternal ICU admission rate in the US was 1.8 per 1,000 births (1)

▪ Our CCOB program was launched in 2024 to standardize our approach to medically complex obstetric patents.

▪ Patients with the COOB designation receive specialized nursing care, telemetry monitoring, and multidisciplinary rounding

led by the obstetric anesthesia team on L&D

▪ We previously evaluated characteristics of CCOB patients with chronic comorbidities (planned), and acute diagnoses

(unplanned), and found unplanned cases were more likely to become critically ill (2)

▪ In this study, we characterized factors associated with ICU transfer and evaluated outcomes of CCOB patients admitted to

an ICU vs those receiving all their critical care in our CCOB unit on L&D, hypothesizing that outcomes would be similar

Background & Hypothesis▪ Starting in 2023, a working group of nurses, obstetricians

and anesthesiologists defined criteria for CCOB designation

at our institution. (figure 1)

▪ The CCOB designation was added to our electronic

medical record, EPIC, in May 2024, allowing all patients

meeting criteria to be reviewed.

▪ Characteristics and outcomes between CCOB patients

transferred to an ICU and those cared for only in the CCOB

unit on L&D were reviewed.

▪ Maternal outcomes included a vasoactive infusion

requirement, quantitative blood loss, hemorrhage, blood

product transfusion, hospital length of stay and CCOB unit

length of stay

Fig 1: Conditions for CCOB Monitoring

Study Design and MethodsResults

Figure 2: ICU location and admission indication▪ There were no significant differences in outcomes between CCOB patients transferred to the

ICU at any time point and those who were not, though confounding by indication was possible.

▪ Some patients were admitted to an ICU before receiving CCOB care.

▪ Patients transferred to an ICU were more likely to be unplanned CCOB and had a septic,

respiratory or neurological CCOB indication.

▪ Future work should focus critical care resources and specialized teams to care for acutely ill

patients on L&D.

▪ This care system can serve as a model for other institutions.

1. NCHS Data Brief, no 485 2023.

2. SOAP Annual Meeting 2025; Abstract ID 2045267

Discussion