Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Abstract

Background:Critical care services are essential for the subset of obstetric patients suffering from severe maternal morbidity. Studies on obstetric critical care are important for benchmarking the issues which need to be addressed while managing critically ill obstetric patients. Although there are several published studies on obstetric critical care from India and abroad, studies from Eastern India are limited. The present study was conducted to fill in this lacuna and to audit the obstetric critical care admissions over a 5 years’ period.Settings and Design:Retrospective cohort study conducted in the general critical care unit (CCU) of a government teaching hospital.Materials and Methods:The records of all obstetric patients managed in the CCU over a span of 5 years (January 2011-December 2015) were analyzed.Results:During the study, 205 obstetric patients were admitted with a CCU admission rate of 2.1 per 1000 deliveries. Obstetric hemorrhage (34.64%) was the most common primary diagnosis among them followed by pregnancy-induced hypertension (26.83%). Severe hemorrhage leading to organ failure (40.48%) was the main direct indication of admission. Invasive ventilation was needed in 75.61% patients, and overall obstetric mortality rate was 33.66%. The median duration (in days) of invasive ventilation was 2 (interquartile range [IQR] 1-7), and the median length of CCU stay (in days) was 5 (IQR 3-9).Conclusions:Adequate number of critical care beds, a dedicated obstetric high dependency unit, and effective coordination between critical care and maternity services may prove helpful in high volume obstetric centers.

Pattern of admissions, clinical course and short term outcome of patients admitted to an obstetric ICU of a tertiary care hospital of north India: a retrospective study

“…The ICU admission rate was found to be 0.4 to 1.2% in other Indian studies. [8][9][10][11][12][13] In developed world the ICU admission rate has been reported to be between 0.7-13.5%. 4 The reason for high ICU admission rate is simply because of poor antenatal supervision, non instituitional deliveries, late recognition of complications and delayed referral.…”

“…8,9 However in some studies obstetric haemorrhage has been reported as the commonest cause of ICU admission. 10,12,13 In one of the studies septicemia has been found to be the commonest indication for ICU admission. 11 In developed countries the indications for admissions have varied between centres primarily because of the different referral nature of these hospitals which might be the reason for the observed heterogeneity.…”

“…In India the maternal mortality has been reported between 12-33%, while perinatal mortality has been reported as 12-47%. 2,[6][7][8][9][10][11][12][13] Four mothers died ,2 because of PPH, 1 of abruptio placentae and 1 of Uterine rupture. Most of maternal deaths that have occurred in other studies have been because of obstetric haemorrhage.…”

“…[1][2][3][4][5][6][7] In India studies have shown pregnancy related hypertensive disorders, obstetric haemorrhages and sepsis to be common indications for ICU admission. [8][9][10][11][12][13] The fetal and maternal outcome in the ICUs also varies between regions. In India the maternal mortality has been reported between 12-33%, while perinatal mortality has been reported as 12-47%.…”

Etio-Pathophysiological Profile and Outcome of Critically Ill Obstetric Patients Admitted to Obstetric Intensive Care Unit at a Tertiary Care Obstetric Hospital in Kashmir Valley: A Retrospective Cohort Analysis.

“…Very few studies have been conducted in India evaluating the reason for ICU admissions of critically ill obstetric patients in tertiary hospitals across India. [10][11][12] The present study was conducted to evaluate the indications for admission, course and outcome of the critically ill obstetric patients in Kashmir valley, in order to evaluate the patient characteristics of critically ill obstetric patients so that high risk obstetric patients are identified early and managed appropriately with early involvement of multidisciplinary obstetric intensive care team.…”