Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India

Abstract

Background Critically ill obstetric patients represent a small proportion of intensive care unit (ICU) admissions. Physiological changes of pregnancy along with pregnancy specific diseases may lead to rapid deterioration of the health status of the parturient warranting ICU care. The present study aims to study the clinical profile and outcomes of the obstetric patients requiring ICU care. Study design and settings Prospective observational study in the multidisciplinary ICU of a tertiary care teaching hospital conducted for a period of 2 years. Materials and methods Demographic details, indication for ICU admission, severity of illness scores, interventions, complications and outcomes of the consecutive obstetric patients transferred to ICU were studied. Results Ninety-one patients were admitted (26 per 1000 deliveries) to the ICU. Majority of them were postpartum (84.6%) and unbooked or referred (63.8%). Hypertensive disorders (24.2%) and obstetric hemorrhage (23.1%) were the major cause for admission to ICU. Forty three patients (47.3%) underwent cesarean delivery. Mechanical ventilation (54.9%), blood transfusion (46%), vasopressor therapy (22%) and dialysis (9.9%) were the various interventions provided in the ICU. Patients with sepsis had high mortality accounting for one third of ICU mortality. The ICU mortality rate was 9.9%. Conclusion The present study showed a clinical profile and outcomes similar to the current scenario of critically ill obstetric patients nationwide. Further studies with a larger sample size may provide a better insight in this population. How to cite this article Sailaja B, Renuka MK, et al . Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India. Indian J of Crit Care Med 2019;23(2):78-82.

Study of maternal outcome in referral obstetric cases in a tertiary care centre

“…Charu et al [14] in their study reported ICU care in 8% cases, which is much higher than our study. However, the ICU admission rate in our study was higher than that of Sailaja[15] Pollock[16] and Harde. [17] These differences could be ascribed to differences in demographics in different regions.…”

Critically Ill Obstetric Patients and Fetomaternal Outcome

“…Of the critically ill pregnant women, maternal mortality was 12.8% and fetal mortality was 40.8%. 4 In another recent study of 91 pregnant ICU patients (26 per 1,000, i.e., 2.6%) by Sailaja and Renuka, 5 almost similar findings were noted. Being a tertiary care center, most patients were postpartum (84.6%) and referred to ones (63.8%).…”

Critically Ill Obstetric Patients: Much more than Meets the Eye

“…Among the other findings, an interesting differentiation of the patients was based on antepartum versus postpartum presentation at the time of ICU admission. The number of postpartum patients was in majority (77/91) as per the results section as well as Table 2 in Sailaja and Renuka 1 while categorizing patients as per trimester of pregnancy, it is depicted that only 21/91 were in postpartum period. This translates to majority of patients being in antepartum rather than postpartum period.…”

“…We read with interest the recently published article by Sailaja and Renuka dealing with epidemiology of critically ill obstetric patients and congratulate the authors for the same. 1 Among the other findings, an interesting differentiation of the patients was based on antepartum versus postpartum presentation at the time of ICU admission. The number of postpartum patients was in majority (77/91) as per the results section as well as Table 2 in Sailaja and Renuka 1 while categorizing patients as per trimester of pregnancy, it is depicted that only 21/91 were in postpartum period.…”

“…We read with interest the recently published article by Sailaja and Renuka dealing with epidemiology of critically ill obstetric patients and congratulate the authors for the same. 1…”