Obstetric intensive care unit admissions and maternal near-miss: insights from a four-year cohort in Turkey

Abstract

Severe maternal complications requiring intensive care unit (ICU) admission remain important indicators of maternal health, particularly in middle-income settings. This study aimed to evaluate the indications for intensive care unit (ICU) admission, maternal and neonatal outcomes, and near-miss events among obstetric patients in a tertiary referral center in Turkey. This retrospective cohort study included all obstetric patients admitted to the ICU of the University of Health Sciences, Başakşehir Çam and Sakura City Hospital between January 2021 and December 2024. Demographic, clinical, and laboratory data, together with maternal and neonatal outcomes, were analyzed using descriptive statistics and appropriate group comparisons ( IBM SPSS Statistics version 25.0, Armonk, NY, USA ). A total of 176 women were included. The mean maternal age was 30.5 ± 6.8 years, and the mean gestational age at ICU admission was 34.4 ± 4.3 weeks. Most admissions occurred in the postpartum period (93.2%). Obstetric hemorrhage (37.5%) and hypertensive disorders (24.4%) were the leading indications of ICU admission. Overall maternal mortality was 5.1%. WHO organ dysfunction (life-threatening condition) criteria were present in 77/176 (43.8%); among survivors ( n  = 167), 68 (40.7%) met the maternal near-miss definition. Mortality was significantly associated with delivery status (vaginal/cesarean/ongoing pregnancy; p  = 0.022), ICU admission during pregnancy ( p  = 0.001), prolonged ICU stay ( p  < 0.001), and sepsis ( p  < 0.001). Non-survivors more frequently required mechanical ventilation, vasoactive drugs, dialysis, blood transfusion, and cardiopulmonary resuscitation. Neonatal outcomes included 91.5% live births and 8.5% stillbirths. Obstetric hemorrhage and hypertensive disorders remain the primary indications for ICU admission, with postpartum women being the most vulnerable group. Incorporating near-miss evaluation offers a more comprehensive assessment of maternal health and provides national data from Turkey, situating outcomes between those reported in high- and low-resource settings. Strengthening postpartum surveillance, ensuring timely recognition of sepsis and hemorrhage, and optimizing critical care interventions are essential strategies to reduce maternal morbidity and mortality.