Obstetric admissions to the critical care unit: a one year experience at a tertiary care referral centre of the developing country

  • Abstract
  • Keywords
  • References
  • PDF
  • Abstract

    Background: Care of the critically ill pregnant women presents a unique challenge as the assessment, monitoring and the treatment must take into account both maternal and fetal wellbeing as well as physiological changes of pregnancy.

    Objective: To assess the indications for critical care unit transfer of obstetric and postpartum cases and describe the profile and feto-maternal outcomes of such patients.

    Methods: This prospective observational study was conducted in department of Obstetrics and Gynaecology of Medical College and Hospital, Kolkata from 1st May 2013 to 30th April 2014.Total 50 cases were included and data was analysed by frequency, percentage, paired and unpaired t test, chi square test and test of equality of proportions using SPSS version 20.

    Results: 0.9% of total obstetric and postpartum admissions required critical care facilities and contributed to 16.67% of CCU admissions. Mean age of patients included in our study was 25.4 years. Most of the patients were admitted antepartum (n=37, 74%) with mean gestational age at admission being 34.2703+6.85018 weeks. More patients presented with obstetric complications (74%, n=37) as compared to medical complications (26%, n=13). The most common indication for admission were major haemorrhage (n=18, 36%) and hypertensive disorders of pregnancy (n=17, 34%). There were 16(32%) maternal deaths. MODS (31.25%) and hypovolemic shock (18.75%) were the most common causes of maternal death in our study.

    Conclusion: The overall mortality was high, emphasizing the need for dedicated obstetric high dependency units.

  • Keywords

    Care; Critical; Obstetric; Tertiary; Unit.

  • References

      [1] Lewinsohn G, Herman A, Leonov Y, Klinowski E (1994) critically ill obstetrical patients: outcome and predictability. Critical Care Medicine; 22:1412–4. https://doi.org/10.1097/00003246-199409000-00010.

      [2] Karnad DR, Lapsia V, Krishnan A, Salvi VS(2004)Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Critical Care Medicine; 32(6): 1294-9. https://doi.org/10.1097/01.CCM.0000128549.72276.00.

      [3] El-Solh AA, Gran BJ (1996) A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest; 110(5): 1299–304. https://doi.org/10.1378/chest.110.5.1299.

      [4] Wakankar R, Patankar A, Humne A, Khadse A (2015) Study of Obstetric Cases Admitted in ICU. SAS Journal of Surgery; 1 (11):11-17.

      [5] Ebirim LN, OjumS (2012) Admissions of obstetric patients in the intensive care Unit: A 5year review. Journal of Medicine and Medical Sciences; 3(11):741- 4.

      [6] Aldawood A (2011) Clinical characteristics and outcomes of critically ill obstetric patients: a ten-year review. Annals of Saudi Medicine; 31:518-22. https://doi.org/10.4103/0256-4947.84631.

      [7] Ghike S, Asegaonkar P(2012)Why obstetric patients are admitted to intensive care unit? A retrospective study. Journal of South Asian Federation of Obstetrics and Gynaecology; 4(2): 90-2. https://doi.org/10.5005/jp-journals-10006-1181.

      [8] Bhadade R, De Souza R, More A, Harde M(2012)Maternal outcomes in critically ill obstetrics patients: A unique challenge. Indian Journal of Critical Care Medicine; 16(1):8-16. https://doi.org/10.4103/0972-5229.94416.

      [9] Gupta S, Naithani U, Doshi V, Bhargava V, Bhavani VS (2011)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; 55(2):146–53. https://doi.org/10.4103/0019-5049.79895.

      [10] Munnur U, Karnad DR, Bandi VD, Lapsia V, Suresh MS, Ramshesh P, et al(2005) Critically ill obstetric patients in an American and an Indian public hospital: Comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes.Intensive Care Med; 31:1087–94. https://doi.org/10.1007/s00134-005-2710-5.

      [11] Yuvel VI, Kaur V, Kaur G, Andappan A, Afzal L(2008) Critical care in obstetrics - scenario in a developing country. Journal of Obstetrics and Gynecology India; 58(3):217-20.

      [12] Zdolsek HJ, Holmgren S, Wedenberg K, Lennmarken C(2009)Circulatory arrest in late pregnancy: caesarean section a vital decision for both mother and child. Acta Anaesthesiology Scandinavia; 53:828–9. https://doi.org/10.1111/j.1399-6576.2009.01970.x.

      [13] Bhat PB, Navada MH, Rao SV, Nagarathna G(2013)Evaluation of obstetric admissions to intensive care unit of a tertiary referral center in coastal India. Indian Journal of Critical Care Medicine; 17: 34–7. https://doi.org/10.4103/0972-5229.112156.

      [14] Leung NY, Lau AC, Chan KK, Yan WW (2010) Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit: A 10-years retrospective review. Hong Kong Medical Journal; 16:18–25.

      [15] Lapinsky SE, Kruczynski K, Seaward GR, et al (1997) Critical care management of the obstetric patient. Canadian Journal of Anaesthesia; 44:325–9. https://doi.org/10.1007/BF03015374.

      [16] Vivian KS, Lo TK, Tsang HH, Lau WL, Leung WC (2014) Intensive care unit admission of obstetric cases: a single centre experience with contemporary update. Hong Kong Medical Journal; 20:24–31.

      [17] Shaik S, Bano N, Abassi R, Balouch R(2013)Obstetric admission to the ICU: A one year review. Medical Channel; 19:59-63.




Article ID: 7446
DOI: 10.14419/ijm.v5i1.7446

Copyright © 2012-2015 Science Publishing Corporation Inc. All rights reserved.