Wendy Pollock Louise Rose Cindy-Lee Dennis Pregnant and postpartum admissions to the intensive care unit: a systematic review Received: 2 September 2009 Accepted: 27 May 2010 Published online: 15 July 2010 Ó Copyright jointly held by Springer and ESICM 2010 Dr. Wendy Pollock prepared the bulk of her contribution to this manuscript whilst at The University of Melbourne. Electronic supplementary material The online version of this article (doi:10.1007/s00134-010-1951-0) contains supplementary material, which is available to authorized users. W. Pollock ( ) ) School of Nursing and Midwifery, La Trobe University/Mercy Hospital for Women, Level 4, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, VIC 3084, Australia e-mail: w.pollock@latrobe.edu.au L. Rose Á C.-L. Dennis Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada Abstract Purpose: To determine the incidence and characteristics of pregnant and postpartum women requiring admission to an intensive care unit (ICU). Methods: Medline, PubMed, EMBASE and CINAHL databases (1990–2008) were system- atically searched for reports of women admitted to the ICU either pregnant or up to 6 weeks post- partum. Two reviewers independently determined study eligibility and abstracted data. Results: A total of 40 eligible studies reporting outcomes for 7,887 women were analysed. All studies were retrospective with the majority reporting data from a single centre. The incidence of ICU admis- sion ranged from 0.7 to 13.5 per 1,000 deliveries. Pregnant or post- partum women accounted for 0.4–16.0% of ICU admissions in study centres. Hypertensive disorders of pregnancy were the most prevalent indication for ICU admission [median 0.9 cases per 1,000 deliveries (range 0.2–6.7)]. There was no difference in the profile of ICU admission in developing compared to developed countries, except for the significantly higher maternal mortality rate in developing countries (median 3.3 vs. 14.0%, p = 0.002). Studies reporting patient outcomes subsequent to ICU admission are lacking. Conclu- sions: ICU admission of pregnant and postpartum women occurs infre- quently, with obstetric conditions responsible for the majority of ICU admissions. The ICU admission pro- file of women was similar in developed and developing countries; however, the maternal mortality rate remains higher for ICUs in develop- ing countries, supporting the need for ongoing service delivery improve- ments. More studies are required to determine the impact of ICU admis- sion for pregnant and postpartum women. Keywords Critical care Á Intensive care Á Severe maternal morbidity Á Severe obstetric morbidity Á Near miss Introduction Mortality remains the sole metric for maternal health in many countries despite low and stable rates in developed countries [1]. Severe maternal morbidity has been pro- posed as an indicator for quality maternal services because of its higher incidence and focus on interventions designed to improve maternal health [2–6]. The preva- lence of severe maternal morbidity remains controversial due to variability in definitional criteria and a lack of established databases to capture information specific to this patient population. Admission to an intensive care unit (ICU) may be considered an objective marker of severe maternal morbidity [7, 8]; however, admission Intensive Care Med (2010) 36:1465–1474 DOI 10.1007/s00134-010-1951-0 REVIEW