Obstetric Patients Requiring Intensive Care: A One Year Retrospective Study in a Tertiary Care Institute in India

Abstract

Background and Objectives. Critically ill obstetric patients are a particularly unique cohort for the intensivist. The objective of this study was to review the indications for admission, demographics, clinical characteristics, and outcomes of obstetric patients admitted to intensive care unit of a medical college hospital in southern India and to identify conditions associated with maternal mortality. Design. Retrospective analysis of pregnant/postpartum (up to 6 weeks) admissions over a 1-year result. We studied 55 patients constituting 11.6% of mixed ICU admissions during the study period. Results. The mean APACHE (acute physiology and chronic health evaluation) II score of patients at admission was 11.8. Most of the patients (76%) were admitted in the antepartum period. The commonest indications for ICU admission were obstetric haemorrhage (51%) and hypertensive disorders of pregnancy (18%). 85% of patients required mechanical ventilation and 78% required inotropic support. Conclusions. Maternal mortality was 13%, and the majority of the deaths were due to disseminated intravascular coagulation and multiorgan failure, following an obstetric haemorrhage. A dedicated obstetric ICU in tertiary hospitals can ensure that there is no delay in patient management and intensive care can be instituted at the earliest.

Study of Obstetric Admissions to the Intensive Care Unit of a Tertiary Care Hospital

“…The commonest surgical procedure performed was the emergency cesarean section (37.12 %). Other studies report a high percentage of cesarean sections among ICU patients, 78.5 % [10], 50.7 % [4], 52.9 % [5], and 67.27 % [20], compared to this study. This indicates that most of the women needed operative delivery.…”

“…Studies done so far report postpartum admissions as the majority. Some studies have reported a majority of antepartum admissions [13,20], and delivery admissions (on the day of delivery) [6,21], some studies have reported a high rate, though not the majority [10,15]. Epidemiology of antepartum admissions needs further research.…”

“…For hypertensive disorders, the range is 7-73.6 % from 24 studies , and the mean is 34.85 %. For obstetric hemorrhage, the range is 11-62.5 %, and the mean is 27.90 % from 23 studies [1][2][3][4][5][6][7][8][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24].…”

Obstetric critical care services in South Africa

“…In contrast to the report from Australia, Ashraf et al, [11] in a retrospective review of ICU admissions in a teaching hospital in India, showed that obstetric haemorrhage and hypertensive disorders were the most common reasons for ICU admission of obstetric patients. Eighty-five per cent of the patients required mechanical ventilation and 78% required inotropic support.…”

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.…”