Cuidado crítico materno: desenlaces y características de los pacientes de una unidad obstétrica combinada de alta dependencia en Medellín, Colombia

Monsalve, Germán A Monsalve; Martínez, Catalina M; Gallo, Tatiana; González, María Virginia; Arango, Gonzalo Correa; Upegui, Alejandro; Castillo, Juan Manuel; González, Juan Guillermo; Rubio, J.; Mojica, Leonardo; Vasco, Mauricio

doi:10.5554/rca.v39i2.96/suffix

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“…HDU facility provides simultaneous expert obstetric care and critical medical care under one roof 11 . The concept of HDU was introduced as a bridge between routine obstetric care and ICU in order to bypass and decrease the ICU burden 12,13 . HDU care is required for women requiring more detailed observation, intervention including basic support for a single failing organ system, extended post-op care and those stepping down from higher levels of care 14,15 .…”

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confidence: 99%

Study of Maternal and Perinatal Outcome in Patients in High Dependency Unit (HDU) in a Tertiary Care Centre

Joshi

Kathaley

Dashrathi

et al. 2019

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Background: It was a retrospective observational study to know demographic factors, indication of High Dependency Unit (HDU) admission, course of stay, maternal and perinatal outcome in patients admitted in HDU in a tertiary care centre. Introduction: Pregnancy and delivery are physiological events. But, they have the potential for life threatening complications. Maternal mortality is an important indicator that reflects quality and adequacy of health care services. Timely intervention and early treatment in patients with high risk pregnancy may reduce further complications i.e. Need of intensive monitoring, morbidity and mortality. Methodology: Total 213 cases with high risk pregnancy admitted in HDU, were included in present study after satisfying inclusion and exclusion criteria. We studied demographic factors, indication of HDU admission and course of stay as well as maternal and perinatal outcome. Results: Majority of the patients i.e. 99 patients (46.48%) were in the age group of 21-25 years. 85 patients i.e. 39.91% were Primigravida while 74 patients i.e. 34.74% were second gravida. Maximum numbers of patients i.e. 173 patients (81.22%) were unregistered. A majority of patients i.e. 136 patients (63.85%) admitted in the HDU had gestational age <37 weeks while 68 patients i.e. 31.93% had gestational age between 37 to 40 weeks. Out of 213 patients, 146 patients i.e. 68.54% had obstetric complications while 67 patients i.e. 31.46% had medical complications. Pre-eclampsia, seen in 74 patients i.e. 34.74%, was the commonest obstetric indication for admission to HDU. Anemia seen in 22 patients i.e. 10.32% was the most common medical indication for HDU admission. Out of 213 patients, 101 patients i.e. 47.42% delivered vaginally, 84 patients i.e. 39.44% underwent caesarean section, 11 patients i.e. 5.16% had abortion whereas 11 patients i.e. 5.16% had ectopic pregnancy. Out of 185 deliveries 131 neonates were perfectly healthy, 37 had still births, 17 needed NICU admission and 9 had Neonatal deaths. Mean HDU stay was 3.31 days. 14 patients out of 213 required ICU care for further management. Mean ICU stay in medical complication group was 0.36 and that for obstetric complication group was 0.19. Out of 213 patients, maternal mortality occurred in 3 patients. Conclusion: Lack of health awareness and delayed referral to tertiary care centre seem to be a major reason for HDU and ICU admission and further maternal and neonatal morbidity and mortality. Timely antenatal registration, antenatal follow ups, prophylactic intervention and anticipation of intensive care can change the scenario hence leading to a decreased maternal morbidity and mortality.

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