An audit of obstetric admissions to intensive care unit in a medical college hospital of central India: lessons in preventing maternal morbidity and mortality

Manisha Jain, Jyoti Nath Modi

Abstract


Background: The spectrum of causes leading to maternal morbidity and mortality may be well reflected in the clinical profile of obstetric patients admitted to the Intensive Care Unit (ICU). An audit of these patients may help in devising intervention strategies and implementing preventive measures. This is expected to contribute to the ongoing concerted multipronged efforts towards reducing maternal mortality as a step towards the millennium development goals. The aim was to study the clinical and demographic profile of antenatal and postpartum women requiring admission to the ICU, the interventions required in these women and the final outcome. The overall goal is to identify the contributing factors towards maternal morbidity and mortality.

Methods: A retrospective analysis of hospital records of all antenatal, post-abortal and postpartum women admitted to the ICU at People’s hospital, Bhopal over a period of 3 years (June 2011 to May 2014).  

Results: A total of 157 records were identified and analyzed: 22 (14%) antenatal, seven (4%) post-abortion, 114 (73%) postpartum, and 14(9%) post-laparotomy women. The mean age was 25 years (Range 18-38 years; SD 4.49), two thirds being from rural areas. Majority (78%) had no earlier visit. The gestational age at admission to ICU ranged from 6-43 weeks (Mean 31 weeks; SD 9.06). One third (24%) of patients had severe anemia, 18 patients needed ventilation, 25 required inotropic support, 4 required dialysis and 17 underwent surgical intervention. Blood or blood component therapy was needed in 60% cases with total blood units transfused being 225. The average duration of stay in intensive care unit was 79 hours. Analyzing as organ-system dysfunctions: Cardiovascular dysfunction (22%), hematological (20%), hepatic (16%), neurological (11%), septicemia (11%), renal (9%). There were 19 maternal deaths.

Conclusions: Maternal anemia and consequences still contribute significantly to maternal morbidity. Non-utilization of antenatal care services especially in rural area compounds the problem. Multidisciplinary care is essential in intensive care setting. 


Keywords


Obstetric, Intensive care unit, Maternal mortality

Full Text:

PDF

References


Special bulletin on maternal mortality in India 2010-12. Sample Registration System office of Registrar General, India, December 2013. Available at: http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2010-12.pdf.

Yuel V. Irene, Kaur Vaneet, Kaur Gurvinder, Andappam Arun, Afzal Lalita. Critical care in obstetrics- scenario in a developing country. J Obstet Gynaecol India. 2008 May-Jun;58(3):217-20.

Turkan Togal, Neslihan Yucel, Ender Gedik, Nurcin Gulhas, H. I. Toprak, M. O. Ersoy. Obstetric admissions to the intensive care unit in a tertiary referral hospital. J Crit Care. 2010;25:628-33.

Disha V. Sahijwani, Ajesh Desai, Vijay Kansara. Analysis of near miss cases as a reflection of emergency obstetric services and need of obstetric ICCU. J South Asian Feder Obstet Gynaecol (JSAFOG). 2013 Sept-Dec;5(3):99-101.

Selo-Ojeme DO, Omosaiye M, Battacharjee P, Kadir RA. Risk factors for obstetric admissions to the intensive care unit in a tertiary hospital: a case-control study. Arch Gynaecol Obstet. 2005;272:207-10.

Tripathi R, Rathore AM, Saran S. Intensive care for critically ill obstetric patients. Int J Gynaecol Obstet. 2000;68:257-8.

Faponle AF, Adenekan AT. Obstetric admissions into the intensive care unit in a sub-urban university teaching hospital. Nepal J Obstet Gynaecol. 2011 Nov-Dec;6(2):33-6.