Maternal and perinatal outcomes in critically ill obstetric patients
Keywords:Critically ill mothers, Intensive care, Mechanical ventilation, Pregnancy complications
Background: The present study was done to analyze the outcome of critically ill antenatal and postnatal women in the intensive care unit (ICU) of a tertiary care teaching hospital. The study was done to identify and analyze the risk factors that influence maternal-perinatal morbidity and mortality.
Methods: All the obstetric patients admitted to ICU during January 2009 to December 2013 were analyzed retrospectively. The indications for transfer to ICU, obstetric and non-obstetric causes were evaluated. Mortality Probability Model (MPM2) score was calculated and risk of mortality estimated. The course and complications during hospital stay were noted.
Results: 57 obstetric patients were admitted during the above mentioned period representing 5/1000 deliveries. Postpartum patients outnumbered antenatal women (31 vs. 26). Obstetric causes- preeclampsia, hemorrhage and sepsis were common indications for admissions. Respiratory failure and the need for mechanical ventilation was the most common reason for critical care. Maternal mortality was 28% and the perinatal mortality was 50%.
Conclusions: Pregnancy-induced hypertensive disorders and hemorrhage were the major risk factors apart from pneumonia and hepatitis that continue to take toll in obstetric patients. Adequate antenatal care, increased vigilance of women during pregnancy for subtle signs and symptoms, early transfer to tertiary centre and aggressive management to prevent complications can bring about the desired reduction in maternal-perinatal morbidity and mortality.
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