NERMİN KELEBEK GİRGİN, Remzi İŞÇİMEN, Banu OTLAR, Ş. Ferda KAHVECİ, Berin ÖZCAN

Yoğun bakım ünitesinde tedavi edilen obstetrik olguların analizi

Amaç: Gebe olgular, hem gebeliğe ve fetusa ait nedenlerden hem de yandaş hastalıkların şiddetlenmesinden dolayı bazen yoğun bakım ünitesi (YBÜ)'nde tedavi edilirler. Çalışmamızda YBÜ'nde tedavi ettiğimiz obstetrik olguların yatış nedenleri ve sıklığı, uygulanan tedavi şekilleri ve sonuçlarını araştırmayı amaçladık. Yöntem: Uludağ Üniversitesi Tıp Fakültesi Etik Kurul onayı alındıktan sonra 1 Ocak 1994-31 Aralık 2005 tarihleri arasında, YBÜ'nde takip edilen 58 obstetrik olgunun kayıtlan retrospektif olarak incelendi. Olguların demografik ve obstetrik verileri, yatış nedenleri, uygulanan tedaviler, yatış süreleri ve tedavi sonuçları kaydedildi. Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II ve Sequential Organ Failure Assessment (SOFA) skoru hesaplandı. Bulgular: Olguların ortalama yaşı 29.4 ± 6.5 yıl, gestasyonel haftası 32.8 ± 6.6 hafta ve en sık yatış nedenleri preeklampsil eklampsi (%29.3), puerperal sepsis (%18.9) ve obstetrik kanama (%17.2) olarak saptandı. Gebelik süresince olguların sadece %27.6'sı düzenli doktor kontrolünde idi. Olguların %89.7'sine mekanik ventilasyon, %86.2'sine kan/kan ürünleri replasmanı uygulanmıştı. Ölen olguların APACHE II, SAPS II skorları yaşayan olgulardan daha yüksekti (p

Anahtar Kelimeler:

Gebelik komplikasyonları, Yatış süresi, Preeklampsi, Geriyedönük çalışma, Yoğun bakım üniteleri, Obstetrik doğum komplikasyonları

An analysis of obstetric patients treated in the intensive care unit

Objective: Obstetric patients are admitted to the intensive care unit (ICU) for reasons related to pregnancy, fetal health and aggravated previous illnesses. This study aims to analyse the reasons for and the frequency of the admissions of obstetric patients to the ICU, their specific treatment and the outcome. Method: After obtaining the approval of the Ethics Committee of Uludağ University Medical Faculty, we analysed retrospectively 58 obstetric admissions to the ICU between 1 January 1994 and 31 December 2005. We recorded demographic and obstetric data, admission diagnosis, specific 'intensive care treatment, duration of stay and outcome. Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Simplified Acute Physiology Scores (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores were collected. Results: The mean age for all the obstetric ICU admissions was 29.4±6.5 years and the mean gestational age was 32.8±6.6 weeks. The most common causes of ICU admissions were preeclampsialeclampsia (29.3%), puerperal sepsis (18.9%) and obstetric haemorrhage (17.2%). Only 27.6% of these obstetric patients had received prenatal care. Mechanical ventilation was provided in 89.7% of the patients and blood or blood component transfusions were required in 86.2% of the cases. There were significant differences in the APACHE II and SAPS II scores between survivors and non-survivors (p<0.05). The mean duration of ICU stay was 12.9±11.7 days and the overall maternal mortality rate was 29.3%. Conclusion: Pregnancy-induced hypertension, puerperal sepsis and obstetric haemorrhage were the main reasons for the admission to the ICU.

Keywords:

Pregnancy Complications, Length of Stay, Pre-Eclampsia, Retrospective Studies, Intensive Care Units, Obstetric Labor Complications,

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