General Obstetrics and Gynecology Obstetrics
Mechanical ventilation in an obstetric population: Characteristics and delivery rates

https://doi.org/10.1067/mob.2003.68Get rights and content

Abstract

Objective: The purpose of this study was to describe the characteristics and outcomes of obstetric patients who require mechanical ventilation. Study design: A review was conducted of obstetric patients who required mechanical ventilation and who received care at our institutions between 1990 and 1998. Data that were collected included maternal demographics, medical condition that necessitated ventilation, delivery status, duration of ventilation, onset of parturition while receiving ventilation, mode of delivery, and maternal and early neonatal morbidity or death. Results: Fifty-one women were identified; 43 women(84%) received care in the labor and delivery setting. The most common admission diagnoses were preeclampsia/eclampsia (44%), labor/preterm labor (14%), and pneumonia (12%). Forty-three women (86%) were undelivered on admission (mean gestational age, 31.6 weeks). Delivery occurred in 37 women (86%) during their admission; 24 women (65%) underwent cesarean delivery. Eleven women began labor while receiving ventilation; 6 were delivered vaginally. The maternal mortality rate was 14% (7/51 women), and the perinatal mortality rate was 11% (4/37 fetuses). Conclusion: A large number of obstetric patients who receive mechanical ventilation will require delivery because of their condition. Centers that care for such women should form a treatment strategy to coordinate obstetric and medical care for this unique population (Am J Obstet Gynecol 2003;188:·549-52.)

Section snippets

Material and Methods

A retrospective chart review was performed on obstetric patients who underwent mechanical ventilation and who received care at our institutions between 1990 and 1998. The institutional review boards of both institutions approved the study before the data collection. Both centers maintain critical care obstetric (CCOB) services within the labor and delivery units for the primary treatment of critically ill patients. Patients who were transferred to the CCOB service were either patients who were

Results

There are 51 patients in this series. General characteristics of the group are listed in Table I.Most patients were undelivered on admission (84%); 69% of them were transferred specifically for CCOB services.

The specific diagnoses that led to the need for mechanical ventilation are listed in Table II.The three most frequent causes were preeclampsia/eclampsia (43%), labor/preterm labor (14%), and pneumonia (12%). Table II also distinguishes whether the patient was cared for in labor and delivery

Comment

Indications for intubation and mechanical ventilation of the obstetric patient have been well described in the literature.5, 6 These indications are similar to the nonobstetric patient population and include inadequate oxygenation, inadequate ventilation, and airway protection but are adjusted to address changes in a pregnant woman's physiologic condition.

Pulmonary and cardiovascular characteristics of gravid patients have many differences as compared to nongravid patients. A pregnant woman has

References (15)

There are more references available in the full text version of this article.

Cited by (76)

  • Acute Respiratory Failure in Pregnancy

    2024, Critical Care Clinics
  • Trauma and Considerations Unique to Pregnancy

    2016, Obstetrics and Gynecology Clinics of North America
    Citation Excerpt :

    Delivery has been shown to decrease Fio2 requirement, but not necessarily improve maternal outcomes.48 However, maternal mortality may be increased by CD.49–51 Therefore, if there is concern that CD would increase immediate mortality, then consideration should be given to no fetal monitoring until this risk is improved.

  • Respiratory Disease in Pregnancy

    2016, Obstetrics: Normal and Problem Pregnancies
  • Mechanical ventilation in critically-ill pregnant women: a case series

    2015, International Journal of Obstetric Anesthesia
View all citing articles on Scopus

Reprints not available from the authors.

View full text