Obstetrics critical care: a 2 years retrospective study in a medical college hospital of western India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20191196Keywords:
Critical care, Haemorrhage, Obstetric, Pregnancy-induced hypertensionAbstract
Background: This study highlights the possibilities of new contribution to the management of high risk pregnancies and those pregnancies with unpredictable outcomes. The objective was to study the incidence and the clinical profile of antenatal and postpartum women requiring admission to the ICU, the interventions required in these women and final outcome.
Methods: A retrospective cohort study of all obstetric critical care admissions during 2-year period from January 2016 to December 2017 was done at 1296 bedded tertiary care hospital. During the study total 349 obstetric patients were admitted to the ICU. The data were analysed by using percentage.
Results: Primigravida (54.73%) were more as compared to multigravida (45.27%). Only 15.76% patients were in antepartum period while majority of patients (84.24%) were admitted during postpartum period. The main obstetric indications for ICU admission were pregnancy-induced hypertension (14.32%) followed by obstetric hemorrhage (9.16%) and community acquired pneumonia (7.44%). Other indications were valvular heart disease (5.44%), ANC with severe anemia (1.72%), monitoring (6.30%). In the present study maternal mortality among the women admitted to ICU was 18.05%. The leading cause of maternal death was obstetric hemorrhage (28.57%) followed by pregnancy induced hypertension (25.40%). An ICU intervention during the stay of the patients in terms of mechanical ventilation was used in 250 (71.63%) cases.
Conclusions: A high quality multidisciplinary care is required in complicated pregnancies for safe motherhood. So, there is a need for dedicated ICU for obstetric patients.
References
Gupta S, Naithani U, Doshi V, Bhargava V, Vijay BS. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric Intensive Care Unit. Indian J Anaesth. 2011;55:146-533.
Dattaray C, Mandal D, Shankar U, Bhattacharya P, Mandal S. Obstetric patients requiring high-dependency unit admission in a tertiary referral centre. Int J Crit Illn Inj Sci. 2013;3:31-5.
Ps R, Verma S, Rai L, Kumar P, Pai MV, Shetty J. “Near miss” obstetricevents and maternal deaths in a tertiary care hospital: An audit. J Preg. 2013;2013:393758.
Gombar S, Ahuja V, Jafra A. A retrospective analysis of obstetric patient's outcome in Intensive Care Unit of a tertiary care center. J Anaesthesiol Clin Pharmacol. 2014;30:502-7.
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.
Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the Intensive Care Unit: A systematic review. Intensive Care Med. 2010;36:1465-74.
Ramachandra Bhat PB, Navada MH, Rao SV, Nagarathna G. Evaluation of obstetric admissions to Intensive Care Unit of a tertiary referral center in coastal India. Indian J Crit Care Med. 2013;17:34-7.
Sriram S, Robertson MS. 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.
Bhadade R, De' Souza R, More A, Harde M. Maternal outcomes in critically ill obstetrics patients: A unique challenge. Indian J Crit Care Med. 2012;16:8-16.
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;69:134-7.
Crozier TM, Wallace EM. Obstetric admissions to an integrated general Intensive Care Unit in a quaternary maternity facility. Aust N Z J Obstet Gynaecol. 2011;51:233-8.
Jain M, Modi JN. An audit of obstetric admissions to Intensive Care Unit in a medical college hospital of central India: Lessons in preventing maternal morbidity and mortality. Int J Reprod Contracept Obstet Gynecol. 2015;4:140-5.
Togal T, Yucel N, Gedik E, Gulhas N, Toprak HI, Ersoy MO. Obstetric admissions to the Intensive Care Unit in a tertiary referral hospital. J Crit Care. 2010;25:628-33.
Zwart JJ, Dupuis JR, Richters A, Ory F, van Roosmalen J. Obstetric intensive care unit admission: A 2-year nationwide population-based cohort study. Intensive Care Med. 2010;36:256-63.
Harde M, Dave S, Wagh S, Gujjar P, Bhadade R, Bapat A. Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia Intensive Care Unit. J Anaesthesiol Clin Pharmacol. 2014;30:508-13.
Ashraf N, Mishra SK, Kundra P, Veena 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.
Pattnaik T, Samal S, Behuria S. Obstetric admissions to the Intensive Care Unit: A five year review. Int J Reprod Contracept Obstet Gynecol. 2015;4:1914-7.
Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of obstetric-related ICU admissions in Maryland: 1999-2008*. Crit Care Med. 2013;41:1844-52.
Jain S, Guleria K, Vaid NB, Suneja A, Ahuja S. Predictors and outcome of obstetric admissions to Intensive Care Unit: A comparative study. Indian J Public Health. 2016;60:159-63.
Karnad DR, Lapsia V, Krishnan A, Salvi VS. Prognostic factors in obstetric patients admitted to an Indian Intensive Care Unit. Crit Care Med. 2004;32:1294-9.
el-Solh AA, Grant BJ. A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest. 1996;110:1299-304.
