---
title: "Utilization of Maternal Intensive Care Units Based on Delivery Method in the U.S."
id: "pubmed-42574682"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42574682"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42574682/"
doi: "10.1213/ANE.0000000000008237"
published_at: "2026-08-10T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Utilization of Maternal Intensive Care Units Based on Delivery Method in the U.S.
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42574682
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42574682/)
- **DOI:** [10.1213/ANE.0000000000008237](https://doi.org/10.1213%2FANE.0000000000008237)
- **Published At:** 2026-08-10T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This study evaluates the **utilization** of Maternal Intensive Care Units (MICUs) based on different modes of delivery in the U.S. - A total of 4.7 million delivery hospitalizations were analyzed from October 2015 to December 2020. - The study categorizes deliveries into vaginal births, intrapartum cesarean births, and intended cesarean births. - ICU admissions occurred in 35,837 cases (0.75% of all deliveries), with rates varying significantly by delivery method: 0.51% for vaginal births, 1.53% for intrapartum cesareans, and 1.12% for intended cesareans. - Severe maternal morbidity (SMM) was reported in 18,552 cases (0.39% of total deliveries), particularly affecting those requiring ICU care, where 18.4% experienced SMM. - The study identifies significant transfusion needs and conditions like cardiomyopathy and preeclampsia as major risk factors for ICU admission. - Findings indicate a critical need for proactive care strategies for patients undergoing intrapartum cesareans to prepare for potential complications.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Maternal Intensive Care Unit Utilization by Mode of Delivery in the United States: A Retrospective Cohort Study [Rebecca S Himmelwright](https://pubmed.ncbi.nlm.nih.gov/?term=Himmelwright+RS&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-2 "Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Alana E Davidson](https://pubmed.ncbi.nlm.nih.gov/?term=Davidson+AE&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Jerome J Federspiel](https://pubmed.ncbi.nlm.nih.gov/?term=Federspiel+JJ&cauthor_id=42574682)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-3 "Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-4 "Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-5 "Department of Population Health Sciences, Duke University, Durham, North Carolina."), [Matthew E Fuller](https://pubmed.ncbi.nlm.nih.gov/?term=Fuller+ME&cauthor_id=42574682)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-6 "Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; and."), [Vijay Krishnamoorthy](https://pubmed.ncbi.nlm.nih.gov/?term=Krishnamoorthy+V&cauthor_id=42574682)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-2 "Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Melissa E Bauer](https://pubmed.ncbi.nlm.nih.gov/?term=Bauer+ME&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Ashraf S Habib](https://pubmed.ncbi.nlm.nih.gov/?term=Habib+AS&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Marie-Louise Meng](https://pubmed.ncbi.nlm.nih.gov/?term=Meng+ML&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#full-view-affiliation-7 "Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.") Affiliations Expand ### Affiliations * 1 From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina. * 2 Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina. * 3 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina. * 4 Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina. * 5 Department of Population Health Sciences, Duke University, Durham, North Carolina. * 6 Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; and. * 7 Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee. * PMID: **42574682** * DOI: [ 10.1213/ANE.0000000000008237 ](https://doi.org/10.1213/ane.0000000000008237) Item in Clipboard # Maternal Intensive Care Unit Utilization by Mode of Delivery in the United States: A Retrospective Cohort Study Rebecca S Himmelwright et al. Anesth Analg. 2026. Show details Display options Display options Format Abstract PubMed PMID Anesth Analg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anesth+Analg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Anesth+Analg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42574682/) . 2026 Aug 10. doi: 10.1213/ANE.0000000000008237. Online ahead of print. ### Authors [Rebecca S Himmelwright](https://pubmed.ncbi.nlm.nih.gov/?term=Himmelwright+RS&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-2 "Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Alana E Davidson](https://pubmed.ncbi.nlm.nih.gov/?term=Davidson+AE&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Jerome J Federspiel](https://pubmed.ncbi.nlm.nih.gov/?term=Federspiel+JJ&cauthor_id=42574682)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-3 "Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-4 "Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-5 "Department of Population Health Sciences, Duke University, Durham, North Carolina."), [Matthew E Fuller](https://pubmed.ncbi.nlm.nih.gov/?term=Fuller+ME&cauthor_id=42574682)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-6 "Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; and."), [Vijay Krishnamoorthy](https://pubmed.ncbi.nlm.nih.gov/?term=Krishnamoorthy+V&cauthor_id=42574682)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-2 "Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Melissa E Bauer](https://pubmed.ncbi.nlm.nih.gov/?term=Bauer+ME&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Ashraf S Habib](https://pubmed.ncbi.nlm.nih.gov/?term=Habib+AS&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina."), [Marie-Louise Meng](https://pubmed.ncbi.nlm.nih.gov/?term=Meng+ML&cauthor_id=42574682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-1 "From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42574682/#short-view-affiliation-7 "Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.") ### Affiliations * 1 From the Division of Women's Anesthesia, Department of Anesthesiology, Duke University, Durham, North Carolina. * 2 Division of Critical Care Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina. * 3 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina. * 4 Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina. * 5 Department of Population Health Sciences, Duke University, Durham, North Carolina. * 6 Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; and. * 7 Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee. * PMID: **42574682** * DOI: [ 10.1213/ANE.0000000000008237 ](https://doi.org/10.1213/ane.0000000000008237) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Improved understanding of intensive care unit (ICU) utilization among obstetric patients is essential for optimizing outcomes, managing severe maternal morbidity (SMM), and guiding resource allocation. Despite the clinical importance of ICU care in obstetrics, large-scale data examining utilization patterns and differences by mode of delivery remain limited. To address this gap, our objectives were to determine the proportion of delivery hospitalizations involving ICU admission, to describe the indications for ICU admissions, and to assess factors associated with ICU admission. **Methods:** We conducted a retrospective cohort study using delivery hospitalizations in the Premier Database (October 1, 2015-December 31, 2020). ICU admission indications were characterized using Centers for Disease Control and Prevention (CDC)-defined SMM events. Mode of delivery was stratified as vaginal birth, intended cesarean birth (cesarean without trial of labor), and intrapartum cesarean birth (cesarean after trial of labor). Multivariable logistic regression was used to evaluate factors associated with ICU admission. We also performed a secondary analysis to determine the rate of ICU admission in non-SMM and SMM patients with and without comorbidities. **Results:** We analyzed 4.7 million delivery hospitalizations; 3261,071/4789,673 (68.1%) were vaginal births, 539,670/4,789,673 (11.3%) intrapartum cesarean births, 988,932/4789,673 (20.6%) intended cesarean births. Overall, 35,837/4789,673 (0.75%) patients required ICU admission, including 16,490/3261,071 (0.51%) vaginal births, 8243/539,670 (1.53%) intrapartum cesarean births, and 11,104/988,932 (1.12%) intended cesarean births. Non-transfusion SMM occurred in 18,552/4789,673 (0.39%) of patients. Among ICU patients, 6574/35,837 (18.4%) experienced non-transfusion SMM events, while 27,329/35,837 (76.3%) patients did not meet criteria for a SMM event. The most common SMM events in the ICU were acute respiratory distress syndrome (2509/35,837; 7.0%), ventilation (2401/35,837; 6.7%), shock (2186/35,837; 6.1%), hysterectomy (2150/35,837; 6.0%), and disseminated intravascular coagulopathy (1433/35,837; 4.0%).In multivariable analysis, both intrapartum cesarean and intended cesarean births were associated with increased odds of ICU admission compared with vaginal birth-adjusted odds ratio (aOR) 1.87 (95% CI, 1.81-1.94) and 1.46 (1.41-1.52), respectively. Additional factors associated with ICU admission included transfusion of ≥4 units of packed red blood cells (aOR 116.3; 95% CI, 110.3-122.7); cardiomyopathy (18.5; 16.7-20.4); preeclampsia with severe features (6.72; 6.48-6.97); pulmonary hypertension (6.53; 5.17-8.25); arrhythmia (3.99; 3.60-4.43); placenta accreta spectrum (3.90; 3.46-4.39); preterm birth (3.55; 3.45-3.66); and chronic renal disease (2.48; 2.24-2.75).In a secondary analysis, SMM occurred in 24,358/2,831,900 (0.9%) patients with comorbidities compared with 4128/1957,773 (0.2%) of patients with no comorbidity present. Additionally, patients with comorbidities without SMM had higher rates of ICU admission across modes of delivery when compared to patients without comorbidities. **Conclusions:** There is approximately one ICU admission per 135 delivery hospitalizations in this US database. Intrapartum and intended cesarean births confer higher risks of ICU admission compared with vaginal birth. Among all investigated factors, significant transfusion requirements were most strongly associated with ICU admission. These findings highlight the importance of early recognition and preparation for potential morbidity associated with intrapartum cesarean birth and underscore the need for proactive obstetric critical care planning. Copyright © 2026 International Anesthesia Research Society. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article. ## References 1. 1. Hoyert DL. Maternal mortality rates in the United States, 2023. In: NCHS Health E Stats. National Center for Health Statistics (US); 2024. 2. 1. Fink DA, Kilday D, Cao Z, et al. Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. JAMA Netw Open. 2023;6:e2317641. 3. 1. Bardenheier BH, Imperatore G, Devlin HM, Kim SY, Cho P, Geiss LS. Trends in pre-pregnancy diabetes among deliveries in 19 U.S. States, 2000-2010. Am J Prev Med. 2015;48:154–161. 4. 1. Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghen WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol. 2012;206:134.e1–134.e8. 5. 1. Fisher SC, Kim SY, Sharma AJ, Rochat R, Morrow B. Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003-2009. Prev Med. 2013;56:372–378. 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