Study of outcome of obstetric emergencies admitted to intensive care unit

B. Rao Bahadur; Prabhadevi Kodey; Jeevitha Tanniru; Suhasini Tirumala

doi:10.18203/2320-1770.ijrcog20182905

Authors

B. Rao Bahadur Department of Obstetrics and Gynecology, NRI Medical College and General Hospital, Chinakakani, Mangalagiri Mandal, Guntur District, Andhra Pradesh, India
Prabhadevi Kodey Department of Obstetrics and Gynecology, NRI Medical College and General Hospital, Chinakakani, Mangalagiri Mandal, Guntur District, Andhra Pradesh, India
Jeevitha Tanniru Department of Obstetrics and Gynecology, NRI Medical College and General Hospital, Chinakakani, Mangalagiri Mandal, Guntur District, Andhra Pradesh, India
Suhasini Tirumala Department of Critical Care Medicine, NRI Medical College and General Hospital, Chinakakani, Mangalagiri Mandal, Guntur District, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20182905

Keywords:

Blood products, ICU, Maternal mortality, PPH, PIH

Abstract

Background: Critically ill obstetric patients pose challenges to the intensive care unit team due to their altered physiology as well as due the presence of the foetus and safety of both the mother and the foetus is of paramount importance.

Methods: All antenatal and postnatal cases within 42days of delivery requiring ICU admission from October 2014 to September 2016. Detailed history taken and outcome noted. Results were subjected to statistical evaluation using SSP software.

Results: (n=75): obstetric reasons (n=51, 68%) of which 21(28%) had PPH and 17(22.6) had hypertensive disorders of pregnancy. Non-obstetric reasons (n=24, 32%) of which 7(9.3%) cases had jaundice and 4(5.3%) had malaria. Mechanical ventilation was needed in the majority of cases (n=44, 58.7%) followed by inotropic support (n=30, 40%).Maternal mortality was 16%. Mortality was higher (n=8, 66.6%) among patients admitted for obstetric reasons as opposed to non-obstetric indications (n=4, 33.3%).

Conclusions: Early detection and prompt referral to the tertiary centre with intensive care facilities should be promoted among the medical fraternity to reduce the incidence of ICU admissions and maternal mortality. All residents of obstetrics and gynaecology should have short mandatory training phase in critical care. Multicentre randomised studies are required for formulating evidence-based national guidelines.

Metrics

Metrics Loading ...

References

Pollock W, Rose L, Dennis C-L. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med. 2010;36(9):1465-74.

Richa F, Karim N, Yazbeck P. Obstetric admissions to the intensive care unit: an eight-year review. J Med Liban. 2008;56(4):215-9.

Making pregnancy safer WHO Regional Office for Europe, 2013. Available at http://www.euro.who.int/pregnancy.

Saha R, Shakya A. Study of obstetric patients admitted to intensive care unit at Kathmandu Medical College Teaching Hospital. Jounal of Kathmandu medical college. 2013;2(4):196-200.

Verma D, Rathore AM. Obstetric admissions to the intensive care unit of a tertiary hospital in northern India. Int J Biomed Res. 2014;5(9):539-42.

Zwart JJ, Dupuis JRO, 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):256-63.

Karnad DR, Lapsia V, Krishnan A, Salvi VS. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med. 2004;32(6):1294-9.

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):134-7.

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):146-53.

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 Peer-Rev Off Publ Indian Soc Crit Care Med. 2013;17(1):34-7.

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:e789450.

Zeeman GG. Obstetric critical care: a blueprint for improved outcomes. Crit Care Med. 2006;34(9 Suppl):S208-214.

Price LC, Germain S, Wyncoll D, Nelson Piercy C. Management of the critically ill obstetric patient. Obs Gynae Reprod Med. 2009;19:350-8.

Natali YWL, Arther CWL, Keeny KCC, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to Intensive Care Unit: a 10 year retrospective review. Honkong Med J. 2010;16:18-25.

Faponle AF, Adenekan AT. Obstetric admission into the Intensive Care Unit in Suburban University Teaching Hospital. Nep J Obstet Gynaecol. 2012;6(2):33-6.

Sadia Khan. An analysis of critically ill obstetric patients admitted to intensive care unit of a tertiary care centre. J Soc Obstet Gynaecol Paksitan. 2012;2(1):37-44.

Lapinsky SE, Kruczynski K, Seaward GR, Farine D, Grossman RF. Critical care management of the obstetric patient. Can J Anaesth J Can Anesth. 1997;44(3):325–9.

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):263-6.

Vasquez DN, Estenssoro E, Canales HS, Reina R, Saenz MG, Das Neves AV, et al. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest. 2007;131(3):718-24.

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):628-33.

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(5):897-903.

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):502-7.