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VOLUME 21 , ISSUE 5 ( May, 2017 ) > List of Articles


Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Sugata Dasgupta, Tulika Jha, Priyojit Bagchi, Shipti Singh, Ramprasad Gorai, Sourav Choudhury

Keywords : Critical care, hemorrhage, obstetric, pregnancy-induced hypertension, ventilation

Citation Information : Dasgupta S, Jha T, Bagchi P, Singh S, Gorai R, Choudhury S. 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.

DOI: 10.4103/ijccm.IJCCM_445_16

License: CC BY-ND 3.0

Published Online: 01-05-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Background: Critical care services are essential for the subset of obstetric patients suffering from severe maternal morbidity. Studies on obstetric critical care are important for benchmarking the issues which need to be addressed while managing critically ill obstetric patients. Although there are several published studies on obstetric critical care from India and abroad, studies from Eastern India are limited. The present study was conducted to fill in this lacuna and to audit the obstetric critical care admissions over a 5 years′ period. Settings and Design: Retrospective cohort study conducted in the general critical care unit (CCU) of a government teaching hospital. Materials and Methods: The records of all obstetric patients managed in the CCU over a span of 5 years (January 2011-December 2015) were analyzed. Results: During the study, 205 obstetric patients were admitted with a CCU admission rate of 2.1 per 1000 deliveries. Obstetric hemorrhage (34.64%) was the most common primary diagnosis among them followed by pregnancy-induced hypertension (26.83%). Severe hemorrhage leading to organ failure (40.48%) was the main direct indication of admission. Invasive ventilation was needed in 75.61% patients, and overall obstetric mortality rate was 33.66%. The median duration (in days) of invasive ventilation was 2 (interquartile range [IQR] 1-7), and the median length of CCU stay (in days) was 5 (IQR 3-9). Conclusions: Adequate number of critical care beds, a dedicated obstetric high dependency unit, and effective coordination between critical care and maternity services may prove helpful in high volume obstetric centers.

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  1. Paruk F, Moodley J. Severe obstetric morbidity. Curr Opin Obstet Gynecol 2001;13:563-8.
  2. Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: A pilot study of a definition for a near-miss. Br J Obstet Gynaecol 1998;105:985-90.
  3. Fitzpatrick C, Halligan A, McKenna P, Coughlan BM, Darling MR, Phelan D. Near miss maternal mortality (NMM). Ir Med J 1992;85:37.
  4. Zeeman GG, Wendel GD Jr., Cunningham FG. A blueprint for obstetric critical care. Am J Obstet Gynecol 2003;188:532-6.
  5. Mjahed K, Hamoudi D, Salmi S, Barrou L. Obstetric patients in a surgical Intensive Care Unit: Prognostic factors and outcome. J Obstet Gynaecol 2006;26:418-23.
  6. Filippi V, Ronsmans C, Gohou V, Goufodji S, Lardi M, Sahel A, et al. Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals. Acta Obstet Gynecol Scand 2005;84:11-6.
  7. Bouvier-Colle MH, Varnoux N, Salanave B, Ancel PY, Bréart G. Case-control study of risk factors for obstetric patients′ admission to Intensive Care Units. Eur J Obstet Gynecol Reprod Biol 1997;74:173-7.
  8. Gilbert TT, Smulian JC, Martin AA, Ananth CV, Scorza W, Scardella AT; Critical Care Obstetric Team. Obstetric admissions to the Intensive Care Unit: Outcomes and severity of illness. Obstet Gynecol 2003;102(5 Pt 1):897-903.
  9. Scarpinato L. Obstetric critical care. Crit Care Med 1998;26:433.
  10. Harrison DA, Penny JA, Yentis SM, Fayek S, Brady AR. Case mix, outcome and activity for obstetric admissions to adult, general critical care units: A secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 2005;9:S25-37.
  11. 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.
  12. 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.
  13. Leung NY, Lau AC, Chan KK, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: A 10-year retrospective review. Hong Kong Med J 2010;16:18-25.
  14. 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.
  15. 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.
  16. Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of obstetric-related ICU admissions in Maryland: 1999-2008FNx01. Crit Care Med 2013;41:1844-52.
  17. 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;55:146-53.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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.
  29. el-Solh AA, Grant BJ. A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest 1996;110:1299-304.
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