Obstetrics ICU admissions: learning objectives
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20191019Keywords:
Comorbidities, Intensive care unit, Monitoring, ObstetricsAbstract
Background: The management of critical illness in pregnancy requires intensive monitoring of obstetric patients in the intensive care unit. Systematic way of surveillance will allow the measurement of outcomes of interest and associated risk factors. Intensive care unit is highly specified and sophisticated area of hospital which is specifically designed, staffed, furnished and equipped, dedicated to the management of critically sick patients, injuries or complications. The aim of this study was to know the frequency of ICU admission in obstetrical patients, to analyse the medical or surgical comorbidity related to obstetrical problems, to segregate the cause of morbidity and to identify the risk reducing strategies.
Methods: This observational study was conducted in 40 ICU patients in present institute from 1st December 2016 to 28th February 2019. The present study was divided into two groups in group I, intervention was done first followed by ICU intervention and in group II, ICU stabilization was done first followed by obstetrical intervention. The parameters noted were age, parity, gestation age, diagnosis on admission, associated medical and surgical comorbidity, reason for ICU admission, any surgical procedure performed, details of treatment given in ICU like ventilator support, blood transfusion, dialysis or ionotropic support. Patients outcome, review of mortality and area of improvement were also noted.
Results: There were 17.5% mortalities observed in present study. The most common ICU intervention was blood transfusion (81.19%) followed by mechanical ventilation (37.8%). Commonest cause of mortality was multiorgan dysfunction (28.5%) followed by hypertensive disorder of pregnancy (14.3%), peripartum cardiomyopathy (14.3%), acute fatty liver of pregnancy (14.3%), septic shock (14.3%) and acute febrile illness (14.3%). Most of the patients were unbooked (74.3%), 47.2% cases did not receive antenatal care.
Conclusions: There is need for antenatal registration of all pregnant women and institutional deliveries should be the aim. There should be antenatal detection and management of medical and surgical comorbidities. There is need for training in emergency obstetrics so that complication can be recognized and managed at an optimum time.
References
Harmer M. Editorial maternal mortality-is it still relevant?. Anaesthesia. 1997;52(2):99-100.
Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of obstetric-related intensive care unit admissions in Maryland: 1999-2008. Crit Care Med. 2013;41(8):1844.
Bandeira AR, Rezende CA, Reis ZS, Barbosa AR, Peret FJ, Cabral AC. Epidemiologic profile, survival and maternal prognosis factors among women at an obstetric intensive care unit. Int J Gynecol Obstet. 2014;124(1):63-6.
Sultan P, Arulkumaran N, Rhodes A. Provision of critical care services for the obstetric population. Best Pract Res Clin Obstet Gynecol. 2013;27(6):803-9.
Baskett TF, O’Connell CM. Maternal critical care in obstetrics. J Obstet Gynecol Can. 2009;31(3):218-21.
Al-Suleiman SA, Qutub HO, Rahman J, Rahman MS. Obstetric admissions to the intensive care unit: a 12-year review. Arch Gynecol Obstet. 2006;274(1):4-8.
Mabie WC, Sibai BM. Treatment in an obstetric intensive care unit. Am J Obstet Gynecol. 1990;162(1):1-4.
Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in United States. Obstet Gynecol. 1988;72(1):91-7.
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(1):8-16.
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(2):159-63.
Keizer JL, Zwart JJ, Meerman RH, Harinck BI, Feuth HD, van Roosmalen J. Obstetric intensive care admissions: a 12-year review in a tertiary care centre. Europ J Obstet Gynecol Reprod Biol. 2006;128(1-2):152-6.
Zwart JJ, Dupuis JR, Richters A, Öry F, van Roosmalen J. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Inten Care Med. 2010;36(2):256-63.
Rathod AT, Malini KV. Study of obstetric admissions to the Intensive Care Unit of a Tertiary Care Hospital. J Obstet Gynecol India. 2016;66(1):12-7.
Zeeman GG, Wendel GD Jr, Cunningham FG. A blueprint for obstetric critical care. Am J Obstet Gynecol. 2003;188(2):532-6.
Vasquez DN, Estenssoro E, Canales HS, Reina R, Saenz MG, Neves AV, Toro MA, Loudet CI. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest. 2007;131(3):718-24.
