Purpose

To synthesise evidence for the incidence of intensive care unit (ICU) admission, characteristics and mortality of pregnant and postpartum women with a focus on differences between high-income countries (HICs) and low-middle-income countries (LMICs) and report changes in reported findings since the last review by Pollock et al. (2010).

Methods

We searched Ovid Medline, EMBASE, and CINAHL (2010–2023), following best practice guidelines for abstract screening for large-evidence systematic reviews. Patient and study characteristics of extracted studies were analysed descriptively. Multivariable meta-regression analysis, employing mixed-effects models, was conducted for assessing ICU admission and mortality. Studies reviewed by Pollock et al. were included to perform an overall analysis, including each study period and geographic region in a model.

Results

Seventy-one eligible studies reported data on 111,601 women admitted to ICU, with 41,291,168 deliveries reported in 65 studies. Fifty-six studies were retrospective. Case definitions, admission criteria, and causes of mortality reported were heterogeneous. The pooled ICU admission rate was 1.6% (95% confidence interval [CI] 1.28–1.99; I² = 99.8%), 0.4% (95% CI 0.32–0.48, I² = 99.9%) in HICs versus 2.8% (95% CI 0.65–6.4, I² = 99.9%) in LMICs (p < 0.0001). The pooled ICU mortality rate among 140,780 admissions reported in 63 studies was 6.5% (95% CI 5.2–7.9; I² = 98.7%), with mortality in HICs 1.4% (95% CI 0.8–2.1, I² = 98.04%) lower than LMICs 12.4% (95% CI 8.1–17.5, I² = 98.9%) (p < 0.0001). Multivariable meta-regression analysis found a significant association between the ICU admission rates (p = 0.0001) and mortality (p = 0.0003) with geographic region (HIC vs LMIC). Compared to the earlier study of Pollock et al. in 2010, there was an increase in reported studies (71 vs 40 in Pollock et al. study) and reported admissions (111,601 vs 7887 Pollock et al. study), particularly from LMICs’.

Conclusions

Mortality for critically ill peripartum women is substantial and the gap in reported ICU admissions and mortality for critically ill peripartum women between HIC and LMICs remains unacceptably high. The reports are often small and heterogeneous using many case definitions. Reporting standards focusing on critical care processes and outcomes and large multinational prospective studies are necessary to better understand and mitigate maternal and child health challenges as sustainable development goals in LMICs and HICs.

中文翻译：

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孕妇和产后妇女的重症监护入院和结局：系统评价

 目的

综合孕妇和产后妇女重症监护病房 （ICU） 入住率、特征和死亡率的证据，重点关注高收入国家 （HIC） 和中低收入国家 （LMIC） 之间的差异，并报告自 Pollock 等人 （2010） 上次综述以来报告结果的变化。

 方法

我们检索了Ovid Medline、EMBASE和CINAHL（2010-2023年），遵循大证据系统综述摘要筛选的最佳实践指南。对提取的研究的患者和研究特征进行了描述性分析。采用混合效应模型进行多变量 meta 回归分析，以评估 ICU 收治率和死亡率。包括 Pollock 等人审查的研究以进行整体分析，包括模型中的每个研究时期和地理区域。

 结果

71 项符合条件的研究报告了 111,601 名入住 ICU 的女性的数据，其中 65 项研究报告了 41,291,168 例分娩。56 项研究是回顾性的。病例定义、入院标准和报告的死亡原因存在异质性。合并 ICU 入住率为 1.6% （95% 置信区间 [CI] 1.28-1.99;I² = 99.8%），高收入国家为 0.4% （95% CI 0.32-0.48，I ² = 99.9%），而低收入和中等收入国家为 2.8% （95% CI 0.65-6.4，I ² = 99.9%） （p < 0.0001）。在 63 项研究中报告的 140,780 例入院病例中，汇总 ICU 死亡率为 6.5%（95% CI 5.2-7.9;I² = 98.7%），高收入国家死亡率为 1.4%（95% CI 0.8-2.1，I ² = 98.04%），低于低收入国家 12.4%（95% CI 8.1-17.5，I ² = 98.9%）（p < 0.0001）。多变量 meta 回归分析发现，ICU 入住率 （p = 0.0001） 和死亡率 （p = 0.0003） 与地理区域 （HIC vs LMIC） 之间存在显着关联。与 2010 年 Pollock 等人的早期研究相比，报告的研究（71 对 Pollock 等人的研究中的 40 人）和报告的入院人数（111,601 人对 Pollock 等人的研究中的 7887 人）有所增加，尤其是来自中低收入国家的入院人数。

 结论

危重围产期妇女的死亡率很高，HIC 和 LMIC 之间报告的 ICU 收治率和危重围产期妇女死亡率的差距仍然高得令人无法接受。这些报告通常很小，并且使用许多案例定义进行异质性分析。关注重症监护过程和结果的报告标准以及大型跨国前瞻性研究对于更好地了解和减轻作为中低收入国家和高收入国家可持续发展目标的孕产妇和儿童健康挑战是必要的。