DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20214347
Published: 2021-10-27

Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

Rehana Rashid, Saniyah Khan Galzie, Javid Ahmed

Abstract


Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.

Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.

Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.

Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity.


Keywords


High risk pregnancy, Obstetric emergency, Obstetric ICU

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References


Kilpatrick SJ, Matthay M. Obstetric patients requiring critical care. A five-year review. Chest. 1992;101:1407-12.

Mabie WC, Sibai BM. Treatment in an obstetric intensive care unit. Am J Obstet Gynecol. 1990;162:1-4.

Umo-Etuk J, Lumley J, Holdcroft A. Critically ill parturient women and admission to intensive care: a 5- year review. Int J Obstet Anesth. 1996;5:79-84.

Wheatley E, Farkas A, Watson D. Obstetric admissions to an intensive therapy unit. Int J Obstet Anesth. 1996;5:221-4.

Collop NA, Sahn SA. Critical illness in pregnancy. An analysis of 20 patients admitted to a medical intensive care unit. Chest. 1993;103:1548-52.

Gilbert TT, Smulian JC, Martin AA, Ananth CV, Scorza W, Scardella AT, et al. Obstetric admissions to the intensive care unit: outcomes and severity of illness. Obstet Gynecol. 2003;102:897.

Mahutte NG, Murphy-Kaulbeck L, Le Q, Solomon J, Benjamin A, Boyd ME. Obstetric admissions to the intensive care unit. Obstet Gynecol. 1999;94:263-6.

Platteau P, Engelhardt T, Moodley J, Muckart DJ. Obstetric and gynaecological patients in an intensive care unit: a 1 year review. Trop Doct. 1997;27:202-6.

Fitzpatrick C, Halligan A, McKenna P, Coughlan BM, Darling MR, Phelan D. Near miss mortality (NMM). Iranian Med J. 1992;85(1):37.

Bewley S, Creighton SB. Near miss obstetric enquiry. J Obstet Gynaecol. 1997;17(1):26-9.

Leung NY, Lau AC, Chan KK, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit: A 10-years retrospective review. Hong Kong Med J. 2010;16:18- 25.

Geller SE, Cox SM, Callaghan WM, Berg CJ. Morbidity and mortality in pregnancy: laying the groundwork for safe motherhood. Womens Health Issues. 2006;16:176

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look Paul FA. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066.

Main EK, Menard MK. Maternal mortality: time for national action. Obstet Gynecol. 2013;122(4):735-6.

Rathod AT, Malini KV. Study of obstetric admissions to the intensive care unit of a tertiary care hospital. J Obstet Gynecol India. 20166;66:12-7.

Ashraf N, Mishra SK, Kundra P, Soundaraghavan S, Habeebullah S. Obstetric patients requiring intensive care: a one year retrospective study in a tertiary care institute in India, Anesthesiol Res Pract. 2014;2014:789450.

Dasgupta S, Jha T, Bagchi P, Singh SS, Gorai R, Choudhury SD. Critically ill obstetric patients in a general critical care unit: a 5 years’ retrospective study in a public teaching hospital of Eastern India. Indian J Crit Care Med. 2017;21(5):294-302.

Ghike S, Asegaonkar P. Why obstetric patients are admitted to Intensive care unit? A retrospective study. J South Asian Feder Obstet Gynaecol. 2012;4(2):90-2.

Vargas M, Marra A, Buonanno P, Iacovazzo C, Schiavone V, Servillo G. Obstetric admissions in icu in a tertiary care center. A 5-years retrospective study. Indian J Crit Care Med. 2019;23(5):213-9.

Soumini G FICOG, Dr. Harini, Study of obstetric ICU admissions and maternal outcome. Int J Med Health Res. 2017;3(10):117-20.

Bibi S, Memon A, Sheikh JM, Qureshi AH. Severe acute maternal morbidity and intens›ve care in a public sector University Hospital of Pakistan. J Ayub Med Coll Abbottabad. 2008;20:109-12.

Sriram S, Robertson MS. 2008. Critically ill obstetric patients in Australia: a retrospective audit of 8 years’ experience in a tertiary intensive care unit. Crit Care Resusc. 2008;10:124-8.

Chawla S, Nakra M, Mohan S, Nambiar BC, Agarwal R, Marwaha A. Why do obstetric patients go to the ICU? A 3 year study. Med J Armed Forces India. 2013;69(2):134.