A Prospective Study of Clinical Characteristics and Interventions Required in Critically Ill Obstetric Patients
Rohit Kumar, Ayush Gupta, Jagdish C Suri
Citation Information :
Kumar R, Gupta A, Suri JC. A Prospective Study of Clinical Characteristics and Interventions Required in Critically Ill Obstetric Patients. Indian J Crit Care Med 2020; 24 (8):677-682.
Introduction: Obstetric patients are a special group of patients whose management is challenged by concerns for fetal viability, altered maternal physiology, and diseases specific to pregnancy. Materials and methods: A prospective analysis of all obstetric patients admitted to the critical care department was done to assess reasons for transfer to the critical care unit (CCU) and the interventions required for management of these patients. Results: Between June 2013 and September 2017, obstetric admission comprised 95 women (5.9%) of the total critical care admissions. There were 77 patients (81.1%) who were discharged from the hospital and 18 patients (18.9%) died. In most of the cases, the primary reasons for shifting the patient to the CCU were severe preeclampsia with pulmonary edema (22.1%), eclampsia (8.4%), acute respiratory distress syndrome (ARDS) (14.7%), and hypovolemic shock in antepartum hemorrhage (APH) and postpartum hemorrhage (PPH) (10.5 and 13.7%, respectively). It was seen that 73 patients (76.8%) required ventilator support, 58 patients (57.4%) required vasopressor support, and intensive hemodynamic monitoring and blood/blood products were transfused in 55 patients (54.5%). The need for ventilator support was more in patients with a lower PaO2/FiO2 and a higher APACHE II score. Patients with a high severity of illness score and a lower PaO2/FiO2 had higher odds of requiring vasopressors. Low hemoglobin at the time of transfer to the CCU and a prolonged hospital stay were found to predict the need for blood transfusion. Conclusion: Obstetric patients are susceptible to critical illnesses but timely management improves the outcome of these young women.
Naylor Jr DF, Olson MM. Critical care obstetrics and gynecology. Crit Care Clin 2003;19(1):127–149. DOI: 10.1016/S0749-0704(02)00059-3.
Kaur M, Sharma J, Gupta P, Singh T, Mustafi S. Obstetric critical care requirements felt by the obstetricians: an experience-based study. J Anaesthesiol Clin Pharmacol 2017;33(3):381–386. DOI: 10.4103/joacp.JOACP_310_15.
Osinaike B, Amanor-Boadu S, Sanusi A. Obstetric intensive care: a developing country experience. Int J Anesthesiol 2006;10(2).
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. Eur J Obstet Gynecol Reprod Biol 2006;128(1-2):152–156. DOI: 10.1016/j.ejogrb.2005.12.013.
Kilpatrick SJ, Matthay MA. Obstetric patients requiring critical care. a five year review. Chest 1992;101(5):1407–1412. DOI: 10.1378/chest.101.5.1407.
Lapinsky SE, Kruczynski K, Seaward GR, Farine D, Grossman RF. Critical care management of the obstetric patient. Can J Anaesth 1997;44(3):325–329. DOI: 10.1007/BF03015374.
Mahutte NG, Murphy-Kaulbeck L, Le Q, Solomon J, Benjamin A, Boyd ME. Obstetric admissions to the intensive care unit. Obstet Gynecol 1999;94(2):263–266. DOI: 10.1097/00006250-199908000-00021.
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(2):146–153. DOI: 10.4103/0019-5049.79895.
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):134–137. DOI: 10.1016/j.mjafi.2012.08.033.
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. DOI: 10.4103/0972-5229.94416.
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. DOI: 10.1155/2014/789450.
Tang LC, Kwok AC, Wong AY, Lee YY, Sun KO, So AP. Critical care in obstetrical patients: an eight-year review. Chin Med J (Engl) 1997;110(12):936–941.
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(3):233–238. DOI: 10.1111/j.1479-828X.2011.01303.x.
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(2):256–263. DOI: 10.1007/s00134-009-1707-x.
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(1):18–25.
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(2):124.
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(4):628–633. DOI: 10.1016/j.jcrc.2010.02.015.
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 2017;4(1):6.
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(4):508–513. DOI: 10.4103/0970-9185.142844.
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(4):502–507. DOI: 10.4103/0970-9185.142843.
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):159–163. DOI: 10.4103/0019-557X.184575.
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(1):34–37. DOI: 10.4103/0972-5229.112156.
Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol 1998;105(9):981–984. DOI: 10.1111/j.1471-0528.1998.tb10261.x.
Bates I, Chapotera G, McKew S, Van Den Broek N. Maternal mortality in Sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115(11):1331–1339. DOI: 10.1111/j.1471-0528.2008.01866.x.