Citation Information :
Sailaja KB. Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India. Indian J Crit Care Med 2019; 23 (2):78-82.
Background: Critically ill obstetric patients represent a small proportion of intensive care unit (ICU) admissions. Physiological changes of pregnancy along with pregnancy specific diseases may lead to rapid deterioration of the health status of the parturient warranting ICU care. The present study aims to study the clinical profile and outcomes of the obstetric patients requiring ICU care.
Study design and settings: Prospective observational study in the multidisciplinary ICU of a tertiary care teaching hospital conducted for a period of 2 years.
Materials and methods: Demographic details, indication for ICU admission, severity of illness scores, interventions, complications and outcomes of the consecutive obstetric patients transferred to ICU were studied.
Results: Ninety-one patients were admitted (26 per 1000 deliveries) to the ICU. Majority of them were postpartum (84.6%) and unbooked or referred (63.8%). Hypertensive disorders (24.2%) and obstetric hemorrhage (23.1%) were the major cause for admission to ICU. Forty three patients (47.3%) underwent cesarean delivery. Mechanical ventilation (54.9%), blood transfusion (46%), vasopressor therapy (22%) and dialysis (9.9%) were the various interventions provided in the ICU. Patients with sepsis had high mortality accounting for one third of ICU mortality. The ICU mortality rate was 9.9%.
Conclusion: The present study showed a clinical profile and outcomes similar to the current scenario of critically ill obstetric patients nationwide. Further studies with a larger sample size may provide a better insight in this population.
WHO U. UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF.
Special report on maternal mortality in India 2014-16, National Institution for Transforming India, Government Of India available at: https://niti.gov.in/content/maternal-mortality-ratio-mmr-100000- live-births
Pollock W, Rose L, et al. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive care medicine. 2010 1;36(9):1465-1474.
Harde M, Dave S, et al. Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit. Journal of anaesthesiology, clinical pharmacology. 2014;30(4):508.
Bhadade R, de'Souza R, et al. Maternal outcomes in critically ill obstetrics patients: A unique challenge. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2012;16(1):8.
Jain S, Guleria K, et al. Predictors and outcome of obstetric admissions to intensive care unit: a comparative study. Indian journal of public health. 2016 1;60(2):159.
Gombar S, Ahuja V, et al. A retrospective analysis of obstetric patient's outcome in intensive care unit of a tertiary care center. Journal of anaesthesiology, clinical pharmacology. 2014;30(4):502.
Dasgupta S, Jha T, et al. Critically ill obstetric patients in a general critical care unit: a 5 years’ retrospective study in a public teaching hospital of Eastern India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2017;21(5):294.
Zwart JJ, Dupuis JR, et al. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Intensive care medicine. 2010 Feb 1;36(2):256-263.
Vasquez DN, Neves AV, et al. Characteristics, outcomes, and predictability of critically ill obstetric patients: a multicenter prospective cohort study. Critical care medicine. 2015 Sep 1;43(9):1887-1897.
Sodhi K, Bansal V, et al. Predictors of mortality in critically ill obstetric patients in a tertiary care intensive care unit: A prospective 18 months study. Journal of Obstetric Anaesthesia and Critical Care. 2018 Jul 1;8(2):73.
Sriram S, Robertson MS. Critically ill obstetric patients in Australia: a retrospective audit of 8 years’ experience in a tertiary intensive care unit. Critical Care and Resuscitation. 2008 Jun;10(2):120.
Gupta S, Naithani U, et al. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit. Indian journal of anaesthesia. 2011 Mar;55(2):146.
Orsini J, Butala A, et al. Clinical profile of obstetric patients admitted to the medical-surgical intensive care unit (MSICU) of an inner-city hospital in New York. Journal of clinical medicine research. 2012 Oct;4(5):314.
Tempe A, Wadhwa L, et al. Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions. Indian Journal of Medical Sciences. 2007 Apr 1;61(4).
Harrison DA, Penny JA, et al. Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care. 2005 Jun;9(3):S25.
Force AD, Ranieri VM, et al. Acute respiratory distress syndrome. Jama. 2012 Jun 20;307(23):2526-2533.
Karnad DR, Lapsia V, et al. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Critical care medicine. 2004 Jun 1;32(6):1294-1299.
Kellum JA, Lameire N, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012 Mar 1;2(1):1-138. https://doi.org/10.1038/ kisup.2012.1
Say L, Chou D, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014 Jun 1;2(6):e323-333.