Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Center in North India
Heena Gupta, Nikita Gandotra, Ruhi Mahajan
Intensive care units, Maternal mortality, Pregnancy, Pregnancy complications
Citation Information :
Gupta H, Gandotra N, Mahajan R. Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Center in North India. Indian J Crit Care Med 2021; 25 (4):388-391.
Background: Critically ill obstetric patients constitute a small number of intensive care unit (ICU) admissions. Physiological changes in pregnancy along with certain pregnancy-specific diseases may cause a rapid worsening of the health status of the patient necessitating ICU care. The present study aims to study the clinical profile of the obstetric patients requiring ICU care.
Materials and methods: It was a retrospective analysis of pregnant/postpartum (up to 6 weeks) admissions over a period of 18 months.
Results: Over these 18 months, 127 women required ICU admission. The most common reasons for ICU admission were obstetric hemorrhage (37.79%) and (pre)eclampsia (28.35%). Ten patients presented with antepartum hemorrhage (placenta previa, placenta accreta, placenta increta). The rest of the patients (n = 38) had atonic postpartum hemorrhage with five having severe anemia. Among the nonobstetric causes (n = 26/127), ICU admission was the most common among those with preexisting heart diseases (n = 10; 7.87%). Forty-nine patients were ventilated mechanically (38.58%), with eclampsia being the most common primary diagnosis (n = 23). We observed 10 maternal deaths (7.87%) with septicemia being the most important cause of death.
Conclusions: Maternal and child health has become an important measure of human and social development. Early diagnosis and prompt treatment of high-risk obstetric patients in a dedicated obstetric ICU in tertiary hospitals can prevent severe maternal morbidity and improve maternal care.
Kim HY, Moon CS. Integrated care center for high risk pregnancy and neonate: an analysis of process and problems in obstetrics. Korean J Perinatol 2014;25(3):140–152. DOI: 10.14734/kjp.2014.25.3.140.
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;102:897–903. DOI: 10.1016/s0029-7844(03)00767-1.
Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med 2010;36(9):1465–1474. DOI: 10.1007/s00134-010-1951-0.
Qureshi R, Irfan Ahmed S, Raza A, Khurshid A, Chishti U. Obstetric patients in intensive care unit: perspective from a teaching hospital in Pakistan. JRSM Open 2016;7(11):2054270416663569. DOI: 10.1177/2054270416663569.
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 Critical Care Med 2013;17(1):34–37. DOI: 10.4103/0972-5229.112156.
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.
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(1):140–145. DOI: 10.5455/2320-1770.ijrcog20150225.
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. PMID: 18522526.
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. PMID: 20124569
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(6):1914–1917. DOI: 10.18203/2320-1770.ijrcog20151285.
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 May;21(5):294–302. DOI: 10.4103/ijccm.IJCCM_445_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(2):134–137. DOI: 10.1016/j.mjafi.2012.08.033.
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.
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.
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.
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(8):1844–1852. DOI: 10.1097/CCM.0b013e31828a3e24.
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.
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.
Mirghani HM, Hamed M, Ezimokhai M, Weerasinghe DS. Pregnancy-related admissions to the intensive care unit. Int J Obstet Anesth 2004;13(2):82–85. DOI: 10.1016/j.ijoa.2003.10.004.