Characteristics and preventability of Obstetric ICU admissions in Far North Queensland

Abstract Background The rarity of maternal deaths in developed countries has increased interest in reviewing cases of severe maternal morbidity or maternal ‘near miss’. Assessment and determining preventability among near misses is therefore important in improving the provision of maternity care. The aims of this study were to (i) describe the epidemiology of intensive care unit (ICU) admission in Far North Queensland (ii) determine the validity of the WHO near miss criteria in determining cases of severe maternal morbidity and (iii) determining preventability of severe maternal outcomes of pregnant and post-partum patients requiring admission to the ICU. Methods Retrospective observational study included all patients pregnant or within 42 days of termination of pregnancy admitted to the Cairns Hospital ICU between 1st January 2013 and 31 December 2017. Cases were reviewed by a team of Obstetricians using the modified Geller model of preventability to determine reasons for admission to ICU and to determine whether the ‘near miss’ was preventable or not.Results Sixty-nine out of 12081 (0.6%) women admitted for Obstetric care were transferred to the ICU with a total of 31 cases fulfilled WHO near miss criteria. The most common primary obstetric related diagnosis for ICU admission were hypertensive disease of pregnancy and obstetric haemorrhage. Indirect obstetric causes contributed to approximately 40% of ICU admissions. Among the 31 cases of WHO near miss, 10 cases were deemed preventable with the most common reason for preventability related to lack of recognition of high-risk clinical status. Conclusion Maternal ‘near miss’ and rates of Obstetric admission to the ICU at Cairns Hospital are reassuringly low. An audit of near miss cases describing preventability is feasible and informs areas for improvement in the management of ‘near miss’ cases.