A study of clinical characteristics and outcome of obstetric patients in intensive care and high dependency unit of a tertiary centre of Jharkhand, India

Authors

  • Samarina Kamal Department of Obstetrics and Gynecology, Alam Hospital and Research Centre Pvt. Ltd., Booty Raod Bariatu, Ranchi Jharkhand, India
  • Vandita Singh Department of Obstetrics and Gynecology, Sadar Hospital, Ranchi, Jharkhand, India
  • Shashibala Singh Department of Obstetrics and Gynecology, RIMS, Ranchi Jharkhand, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20196054

Keywords:

Haemorrhage, Haemolysis elevated liver enzymes low platelet syndrome, High dependency unit, Intensive care unit

Abstract

Background: Few women during their pregnancy, labour and postnatal period require critical care related to the pregnancy itself, aggravation of a pre-existing illness and complications of the delivery. Pregnant patients account for a small number of ICU admission - 2-10% two main indications for admission are hypertensive disorders (17.2%-46%) and massive haemorrhage (10%-32.8%). The primary objective of the present study was to review the characteristics of the obstetric patients admitted to our ICU over a 2-year period.

Methods: It was a prospective study conducted over 50 patients in high dependency and intensive care unit at Alam hospital over a period of 2 years (October 2014 to October 2016).

Results: During the study period a total of 50 obstetric patients were transferred to the intensive care unit (ICU). Antenatal care played significant role in the obstetric outcome. 84% of patients transferred to the ICU during the study period had inadequate or no antenatal care, while 8% were booked in their pregnancy and had adequate antenatal care. ICU interventions included mechanical ventilation used in 20(40%) patients, blood and blood product transfusion in 35(70%) patients’ inotropes in 20 patients (40%) antihypertensive therapy in 20 patients (40%), arterial embolization in 2(4%) patients. Maternal mortality was seen in 10 patients (20%).

Conclusions: There is a need for training in emergency obstetrics so that the complication can be managed right at the time of occurrence.

References

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

Zeeman GG, Wendel GD, Cunningham FG. A blueprint forobstetric critical care. Am J Obstet Gynecol. 2003;188:532-6.

Sadler LC, Austin DM, Masson VL, McArthur CJ, McLintock C, Rhodes SP, et al. Review of contributory factors in maternity admissions to intensive care at a New Zealand tertiary hospital. Am J Obstet Gynecol. 2013;209:549.e1-7.

Keizer JL, Zwart JJ, Meerman RH, Harinck BI, Feuth HD, van Roosmalen J. Obstetric intensive care admissions: a 12-year review in a tertiary care centre. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):152-6.

Zwart JJ, Dupuis JR, Richters A, Öry F, van Roosmalen J. Obstetric intensive careunit admission: a 2-year nationwide population-based cohortstudy. Intensive Care Med. 2010;36(2):256-63.

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):1844-52.

Baskett TF, O’Connell CM. Maternal critical care in obstetrics. J Obstet Gynaecol Can. 2009;31(3):218-21.

Ibrahim IA, Rayis DA, Alsammani MA, Adam I. Obstetric andgynecologic admissions to the intensive care unit at Khartoum Hospital, Sudan. Int J Gynecol Obstet. 2015;129(1):84.

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 Anesth. 2011;55(2):146-53.

Irene YV, Vaneet K, Gurvinder K, Arun A, Lalita A. Critical care in obstetrics-scenario in a developing country. J Obstet Gynecol India. 2008;58(3):217-20.

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

Tempe A, Wadhwa L, Gupta S, Bansal S, Satyanarayana L. Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions. Indian J Med Sci. 2007;61:179-85.

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):140-5.

Leung NY, Lau AC, Chan KK, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit: A 10 year’s retrospective review. Hong Kong Med J. 2010;16:18-25.

Shaikh S, Shaikh NB, Abassi R, Balouch R. Obstetric admission to the intensive care unit: a one year review. Med Channel. 2013;19:59-63.

Monsalve GA, Martínez C, Gallo T, González MV, Arango G, Upegui A, et al. Maternal critical care: outcomes and patient characteristics in a combined obstetric high dependency unit in Medellin, Colombia. Rev Col Anest. 2011;39:190-205.

Togal T, Yucel N, Gedik E, Gulhas N, Toprak HI, Ercoy O. Obstetric admissions to the intensive care unit in a tertiary referral hospital. J Critical Care. 2010;25:628-33.

Kumar V. Critical illness in pregnancy. Med Update. 2012;22:700-10.

Suarez JR, Duenas C, Paternina A, Miranda J, Castillo E, Bourjeily G. Clinical characteristics and outcomes of obstetric patients requiring mechanical ventilation in Colombia. Chest. 2012;10:142.

Barrett H, Devin R, Clarke S, Dekker Nitert M, Boots R, Fagermo N, et al. A fifteen-year retrospective review of obstetric patients requiring critical care. Obstet Med. 2012;5:166-70.

Simsek T, Eyigor C, Uyar M, Karaman S, Moral AR. Retrospective review of critically ill obstetrical patients:a decade’s experience. Turk J Med Sci. 2011;41:1059-64.

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Published

2019-12-26

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Original Research Articles