TOPLINE

Intrapartum cesarean birth and intended cesarean birth were associated with higher odds of ICU admission compared to vaginal birth.

METHODOLOGY

• Researchers conducted a retrospective cohort study using the Premier Healthcare Database including data on in-hospital births in the United States (2015-2020).
• A total of 4,789,673 delivery hospitalizations were included: 3,261,071 vaginal births, 539,670 intrapartum cesarean births, and 988,932 intended cesarean births.
• The primary outcomes were ICU admission during delivery hospitalization and severe maternal morbidity (SMM) events.
• Secondary outcomes were ICU length of stay, ICU-level interventions and complications, maternal mortality, and 42-day and 90-day readmission rates.

TAKEAWAY

• Overall, ICU admission occurred in 0.75% of delivery hospitalizations: 0.51% of vaginal births, 1.53% of  intrapartum cesarean births, and 1.12% of intended cesarean births. SMM rates were highest for intrapartum cesarean births across all categories, except hysterectomy, with acute respiratory distress syndrome being the most frequent.
• Compared to vaginal birth, intrapartum cesarean birth was associated with increased odds of ICU admission (adjusted odds ratio [aOR], 1.87; 95% CI, 1.81-1.94), and intended cesarean birth was also associated with increased odds of ICU admission (aOR, 1.46; 95% CI, 1.41-1.52).
• Transfusion of four or more units of packed red blood cells was the strongest predictor of ICU admission (aOR, 116.3; 95% CI, 110.3-122.7), followed by cardiomyopathy (aOR, 18.5; 95% CI, 16.7-20.4).
• In-hospital maternal mortality rates were 0.3, 1.5, and 1.3 per 10,000 for vaginal, intrapartum cesarean, and intended cesarean births, respectively; among ICU patients, mortality rates were 24.9, 52.2, and 68.4 per 10,000 for these delivery groups.

IN PRACTICE

"Our findings have implications for obstetric care planning. Antepartum risk assessment may be helpful in identifying patients at increased risk of ICU admission and ensuring they are planned for delivery in an appropriate center," the authors of the study wrote. "Unfortunately, the need for obstetric ICU admission remains difficult to predict. For this reason, all birth hospitals must maintain readiness for patients who require ICU-level care," they added.

SOURCE

The study was led by Rebecca S. Himmelwright, MD, and Alana E. Davidson, BS, Division of Women’s Anesthesia, Department of Anesthesiology, Duke University in Durham, North Carolina. It was published online on August 10 in Anesthesia and Analgesia.

LIMITATIONS

The study relied on administrative database, and precise indications for admission to ICU could not be determined. Information on timing of ICU admission relative to delivery was lacking. Cause of death could not be determined.

DISCLOSURES

One author was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development and disclosed having consulting agreements. Another author reported receiving research support and being a section editor for the Obstetric Anesthesia section for Anesthesia & Analgesia.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.