A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study

Miglani, Urvashi; PATHAK, ANJALI; Laul, Poonam; Sarangi, Sushmita; Gandhi, Shalini; Miglani, Sanjeev; Laul, Anish

doi:10.5005/jp-journals-10071-23657

Cited by 6 publications

(14 citation statements)

References 11 publications

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“…However, it was observed that the general scores were not able to accurately predict the outcomes of pregnant women in the critical care due to the physiological changes in pregnancy which have a bearing on the variables of these models; another reason being that many critical conditions improved remarkably after delivery of the fetus and placenta, leading to over prediction of mortality by the general scores. 12 , 13 , 16 , 18 – 24 Thus, the need for customization of the scores for obstetric patients was perceived. This led to development of specific ObPMs.…”

Section: Ethodsmentioning

confidence: 99%

“… 25 It has three components, namely physiological variables (12 in number), age points, and chronic health points. Multiple authors, except Miglani et al, have reported overestimation of maternal mortality in obstetric patients using the APACHE II scores, including a comprehensive global analysis by Ryan et al 12 , 13 , 16 , 18 – 23 , 24 This overprediction was especially prominent in patients getting admitted for direct obstetric causes. 16 However, modified APACHE II scores (customized for obstetric population) could accurately (SMR: 0.86) predict mortality rates when compared with APACHE II (SMR: 0.36) in a study conducted by Paternina-Caicedo et al 26 Higher scores have been consistently associated with increasing risks of nonsurvival, near miss, need for advanced organ system support, prolonged ICU-LOS, perinatal mortality, and delay in hospital admissions (level 2 delay).…”

Section: Ethodsmentioning

confidence: 99%

“… 16 However, modified APACHE II scores (customized for obstetric population) could accurately (SMR: 0.86) predict mortality rates when compared with APACHE II (SMR: 0.36) in a study conducted by Paternina-Caicedo et al 26 Higher scores have been consistently associated with increasing risks of nonsurvival, near miss, need for advanced organ system support, prolonged ICU-LOS, perinatal mortality, and delay in hospital admissions (level 2 delay). 12 – 14 , 18 , 21 , 27 – 29 …”

Section: Ethodsmentioning

confidence: 99%

“…In a prospective cross-sectional study on 124 subjects, Miglani et al reported that there is an increase in perinatal mortality with rising APACHE II scores ( p = 0.001). 18 …”

Section: Ethodsmentioning

confidence: 99%

“… 56 Other factors associated with poor fetal and neonatal outcomes are maternal hypertension, maternal cardiac diseases, maternal sepsis, delays in presentation to the ICU, and increasing duration of delay. 18 , 57 …”

Section: Ethodsmentioning

confidence: 99%

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Prognosticating Fetomaternal ICU Outcomes

Suri¹,

Khanam²

2022

Indian Journal of Critical Care Medicine

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A bstract Although no scoring system is as yet fully validated for predicting maternal outcomes in critically ill obstetric patients, prognostication may be done objectively using severity predicting models. General critical care scoring systems which have been studied in obstetric patients are outcome prediction models (Acute Physiology and Chronic Health Evaluation [APACHE] I-IV, Simplified Acute Physiology Score [SAPS] I-III, Mortality Probability Model [MPM] I-IV) and organ dysfunction scores (Multiple Organ Dysfunction Score [MODS], Logistic Organ Dysfunction Score [LODS], Sequential Organ Failure Assessment [SOFA]). General critical care scoring systems may overpredict mortality rates in obstetric patients secondary to an altered physiology of organ systems during pregnancy. Obstetric prediction models were developed keeping in mind the physiological characteristics of obstetric population. They are Modified Early Obstetric Warning System (MEOWS), Obstetric Early Warning Score (OEWS), Maternal Early Warning Trigger (MEWT), and disease-specific obstetric scoring systems. The APACHE II model and MPM II are most often used scoring systems for predicting maternal mortality. The SOFA model is the best predictive model for sepsis in obstetrics. APACHE II and SAPS are more useful for nonobstetric population. Recent studies have also underscored the applicability of the OEWS in intensive care unit (ICU) settings with results comparable to the more elaborate APACHE II and SOFA scores. The Early Warning System helps in identifying acutely deteriorating pregnant and postpartum women in non-ICU settings who may require critical care. Fetal outcomes are largely dependent upon maternal outcomes. Prognostic systems applied to mothers may help in estimation of perinatal mortality and morbidity. How to cite this article Suri J, Khanam Z. Prognosticating Fetomaternal ICU Outcomes. Indian J Crit Care Med 2021;25(Suppl 3):S206–S222.

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Section: Ethodsmentioning

confidence: 99%

Section: Ethodsmentioning

confidence: 99%

Section: Ethodsmentioning

confidence: 99%

“…In a prospective cross-sectional study on 124 subjects, Miglani et al reported that there is an increase in perinatal mortality with rising APACHE II scores ( p = 0.001). 18 …”

Section: Ethodsmentioning

confidence: 99%

Section: Ethodsmentioning

confidence: 99%

See 3 more Smart Citations

Prognosticating Fetomaternal ICU Outcomes

Suri¹,

Khanam²

2022

Indian Journal of Critical Care Medicine

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Social determinants and exposure to intimate partner violence in women with severe acute maternal morbidity in the intensive care unit: a systematic review

Ayala Quintanilla,

Taft,

McDonald

et al. 2023

BMC Pregnancy Childbirth

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Background Studying severe acute maternal morbidity in the intensive care unit improves our understanding of potential factors affecting maternal health. Aim To review evidence on maternal exposure to intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit. Methods The protocol for this review was registered in PROSPERO (registration number CRD42016037492). A systematic search was performed in MEDLINE, CINAHL, ProQuest, LILACS and SciELO using the search terms “intensive care unit”, “intensive care”, “critical care” and “critically ill” in combination with “intimate partner violence”, “social determinants of health”, “severe acute maternal morbidity”, pregnancy, postpartum and other similar terms. Eligible studies were (i) quantitative, (ii) published in English and Spanish, (iii) from 2000 to 2021, (iv) with data related to intimate partner violence and/or social determinants of health, and (v) investigating severe acute maternal morbidity (maternity patients treated in the intensive care unit during pregnancy, childbirth or within 42 days of pregnancy termination). Of 52,866 studies initially identified, 1087 full texts were assessed and 156 studies included. Studies were independently assessed by two reviewers for screening, revision, quality assessment and abstracted data. Studies were categorised into high/middle/low-income countries and summarised data were presented using a narrative description, due to heterogenic data as: (i) exposure to intimate partner violence and (ii) social determinants of health. Results One study assessed intimate partner violence among mothers with severe acute maternal morbidity in the intensive care unit and found that women exposed to intimate partner violence before and during pregnancy had a nearly four-fold risk of severe acute maternal morbidity requiring ICU admission. Few social determinants of health other than age were reported in most studies. Conclusion This review identified a significant gap in knowledge concerning intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit, which is essential to better understand the complete picture of the maternal morbidity spectrum and reduce maternal mortality.

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Utility in the obstetric high dependency unit and intensive care unit in tertiary medical center in Ethiopia: a comparative cross-sectional study

Jegora,

Ahmed,

Mohamed

et al. 2024

Int J Reprod Contracept Obstet Gynecol

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Background: Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two-thirds of these deaths occurred in sub-Saharan Africa. This study aims to assess the utility of the obstetric high dependency unit and intensive care unit and maternal outcome in a tertiary medical center in Ethiopia. Methods: A comparative cross-sectional study was conducted on critically ill obstetric clients admitted to St. Paul's Hospital Millennium medical college obstetric HDU from October 2020 to September 2022 and before the establishment of the obstetric HDU (who were admitted to the medical ICU). Binary and multivariate logistic regression was conducted to identify factors associated with maternal mortality before the establishment of the maternal HDU. Results: The minimum duration in both units was one day. The maximum duration was 14 days for HDU and 26 days for ICU. Following the establishment of the maternity HDU, the ICU admission rate decreased to 1.2 per 1000 deliveries. Obstetric patients diagnosed with DIC and HELLP syndrome upon admission to the ICU had a 4.9 times higher risk of mortality compared to their counterparts. Obstetric women admitted to the ICU and treated with inotropic agents or vasopressors had a 33.8 times higher risk of mortality compared to their counterparts. Conclusions: Obstetric admissions to the ICU significantly decreased following the establishment of the maternity HDU. Obstetric patients diagnosed with DIC and HELLP syndrome are more likely to develop unfavorably outcome.

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A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study

Cited by 6 publications

References 11 publications

Prognosticating Fetomaternal ICU Outcomes

Prognosticating Fetomaternal ICU Outcomes

Social determinants and exposure to intimate partner violence in women with severe acute maternal morbidity in the intensive care unit: a systematic review

Utility in the obstetric high dependency unit and intensive care unit in tertiary medical center in Ethiopia: a comparative cross-sectional study

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