The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following conclusions are based on good and consistent scientific evidence (Level A):
- Pregnancy changes normal laboratory values and physiologic parameters.
- Approximately 75% of obstetric intensive care unit (ICU) patients are admitted to the unit postpartum.
- Hemorrhage and hypertension are the most common causes of admission from obstetric services to intensive care.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Cesarean delivery in the ICU should be restricted to cases in which transport to the operating room or delivery room cannot be achieved safely or expeditiously, or to a perimortem procedure.
- Treatment of sepsis should not await admission to an ICU but should begin as soon as septic shock is diagnosed.
The following recommendations and conclusions are based primarily on consensus and expert opinion (Level C):
- High-intensity ICU physician staffing is associated with lower ICU mortality rates, lower hospital mortality rates, and decreased length of stay in both the ICU and a hospital, compared with models in which intensivist consultation is optional.
- Decisions about care for a pregnant patient in the ICU should be made collaboratively with the intensivist, obstetrician, specialty nurses, and neonatologist.
- The care of any pregnant woman requiring ICU services should be managed in a facility with obstetric adult ICU and neonatal ICU capability.
- Necessary medications should not be withheld from a pregnant woman because of fetal concerns.
- Necessary imaging studies should not be withheld out of potential concern for fetal status, although attempts should be made to limit fetal radiation exposure during diagnostic testing.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
