To analyze obstetric admissions to intensive care unit and to identify the risk factors responsible for intensive care admission (original) (raw)
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Pregnancy though physiological and can be associated with major maternal morbidity with potential catastrophic consequences requiring utilization of facilities of Intensive Care Unit (ICU) Reports regarding such admissions are few from developing countries. Objective: To study the indication for admission, intervention and outcome of obstetric patients admitted to intensive care unit and also to identify risk factors for admission to intensive care unit at Government General Hospital, Kakinada, AP, India. Methods: A hospital based descriptive observational study was conducted in month of April and May 2017. All obstetric admissions to the ICU up to 42 days postpartum were included. Data obtained included demography, obstetric history, pre-existing medical problems, indication for ICU admission, intervention in ICU and outcome. Risk factors were assessed by comparing cases with control which included women who delivered before and after the indexed cases. Results: A total of 200 obstetric patients admitted in ICU during the study period. This accounts for 20% of total hospital deliveries and 12.5% of all ICU admissions. Eighty Five percent of the patients were admitted due to hypertensive disorders of pregnancy. Fourty Seven percent patients were of obstetric haemorrhage. Heart diseases topped the list with 8% in non-obstetric group. Risk factors for admission included lesser gestational age, Caesarean-section, blood loss and co-morbid conditions of the patient. Mean age was 24.5±4.8 years; Inotropic support was received by six patients (6%), CVP monitoring was done in three patients (3%). Ventilator support was needed in six (6%). There were three cases (3%) of mortality which accounts for 2.09% of total ICU mortality. Twenty Eight patients (28%) were referred from other centres. Conclusion: Hypertensive disorders of pregnancy, Obstetric haemorrhage and Heart disease were the most common indications of ICU admissions. Risk factors for admission included lesser gestational age, caesarean section, blood loss, and co-morbid conditions of the patients. Optimal outcome was achieved with combined effort of multidisciplinary team.
International Journal of Advanced Research (IJAR), 2019
Background: Obstetrics emergencies pose a major challenge to obstetricians and should be managed by multidisciplinary team in ICU. Objectives: To analyse the demographic pattern, cause of admission ,intervention and maternal outcome in obstetric patients admitted in ICU. Material and methods: A retrospective observational analysis of 58 obstetric patients admitted and managed in ICU was done. The parameters studied were cause of ICU admission, intervention and outcome of such patients. Results: Only 58 patients were admitted to ICU over a period of two years which constitutes 0.29% of all the deliveries and 0.27% of all emergency obstetric admissions. The main obstetric indications for ICU admissions were ectopic pregnancy(25.86%), postpartum haemorhage(22.41%) followed by hypertensive disorders(20.68%), antepartum haemorhage(6.89%) and medical disorders(5.17%) The mortality rate among the women admitted in ICU was 8.62%.
Obstetric Cases In Intensive Care Unit
Perinatal Journal, 2011
Objective: Aim of this study is to evaluate retrospectively obstetric cases to determine the causes and outcomes of intensive care unit. Methods: Total 6000 patients referred to ICU from 2005 to 2010 21 patients were referred to ICU because of obstetric diseases. 11 patients (52%) were delivered to university hospital from other hospital, 10 patient (48%) were also transferred to ICU from obstetric and gynecologic department. 62% were pregnant, 38% postpartum period were received to ICU because of obstetrics diseases. Mean age of 21 patients is 34.7±7.9 years. Mean age of survivors is 34.9±8, Mean age of non-survivors 32.0. ICU stay is 2.3±2.5 days. There were differences ICU stay between survivors and non-survivors (p<0.05). While ICU stay of survivors is 2.1±2.4 days, ICU stay of non-survivors is 6 days. Most common reasons about obstetric of ICU admittance were postpartum hemorrhage (57%) and hypertension related to eclampsia/preeclampsia (10%). One of patients died and mortality rate was found as 5%. Results: In this study; 21 obstetric patients referred to ICU (intensive care unit) from 2005 to 2010 in pregnancy and/or postpartum period, were evaluated by observing demographic data, admittance reasons, interventions in ICU and clinical outcomes. Conclusion: ICU requirement for obstetric cases was seen mostly because of obstetric hemorrhage and uncontrolled hypertension. Strategies improved for solving these problems and regular antenatal care would significantly decrease major maternal morbidity and mortality.
Study of Obstetric Admissions to the Intensive Care Unit of a Tertiary Care Hospital
The Journal of Obstetrics and Gynecology of India, 2015
Purpose To analyze obstetric admissions to intensive care unit and to identify the risk factors responsible for intensive care admission. Methods This is a retrospective study of all obstetric cases admitted to the intensive care unit over a period of 3 years. Data were collected from case records. The risk factors responsible for ICU admission were analyzed. Results There were 765 obstetric admissions to ICU accounting for 1.24 % of all deliveries. 56.20 % were in the age group of 20-25 years. 38.43 % were in their first pregnancy. 36.48 % of cases were at 37-40 weeks of gestation. Postpartum admissions were 80.91 %. Major conditions responsible were obstetric hemorrhage in 44.05 %, hypertensive disorders of pregnancy in 28.88 %, severe anemia in 14.37 %, heart disease in 12.15 %, and sepsis in 7.97 % of ICU cases. 40.39 % cases required high dependency care. Maternal mortality was seen in 15.55 % of ICU cases. Commonest cause of mortality was hemorrhagic shock (26.89 %) and multiorgan dysfunction syndrome (26.05 %). Conclusion Commonest risk factors for ICU admissions are obstetric hemorrhage and hypertensive disorders of pregnancy. Other major risk factors are severe anemia, heart disease, sepsis, more than one diagnosis on admission, and the need for cesarean delivery.
Obstetric admissions to the intensive care unit: a five year review
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
Background: Care of the critically ill obstetric patients is a unique challenge particularly because of its unpredictability. The outcome in these patients would not only contribute to the assessment of the quality of patient care but would also enhance the risk stratification of pregnant patients in the evaluation of new therapies. This study is intended to review a series of critically ill obstetric patients admitted to our ICU to assess the spectrum of disease, required interventions, and maternal outcome, and to identify conditions associated with maternal death. Methods: This retrospective cohort study was conducted in 16-bed medical and surgical ICU in a 500 bedded tertiary care hospital over a period of 5 years (2009-2013) at Bhubaneswar, Odisha, India. Results: Only 54 obstetric patients were admitted to the ICU which constitutes 2.09% of all ICU admissions, 0.78% of emergency obstetric admissions and 0.9% of the total deliveries. Majority of patients (79.62%) were admitted during postpartum period. The leading obstetric indication for ICU admission was obstetric hemorrhages (29.6%). Ectopic pregnancy was common (7 patients) among the obstetric hemorrhages. In the present study maternal mortality was 16.6%, while 70.3% were improved after treatment. The main cause of maternal death was obstetric haemorrhage (55.5%). ICU interventions during the stay of the patients in terms of mechanical ventilation were used in 72.2% of cases. Other interventions included blood & blood product transfusion in 30 (55.5%), inotropes in 34 (62.9%), antihypertensive in 14 (25.9%), anticonvulsant in 16 (29.6%) & dialysis in 4 (7.4%) cases. Conclusions: The need of ICU management for obstetric conditions is on rising trend. The need for ventilatory or inotropic support may predict poor outcome. An adequate adoption of safe motherhood initiative would reduce obstetric ICU admissions and thereby will also reduce the maternal mortality.
Profile of obstetric patients requiring ICU care
Aims and Objectives of study: The aim was to study incidence, indications and immediate outcome of obstetric patients admitted in ICU, to assess morbidity and mortality of these patients and to assess risk factors leading to ICU admissions. Methods: In this cross sectional study, from January 2009 to July 2010, 102 obstetric patients were analysed for critical illness for ICUs (medical and surgical) admissions the Descriptive analysis study was done considering Total Obstetric Admissions(Antenatal, intra and Postnatal including Abortions) in ICU, residence, Indications of ICU Admission, Mean SOFA scores on various days of ICU stay, requirement of blood components and maternal mortality during ICU stay were studied. Cross tables and frequency tables with percentage, correlation and regression and statistical analysis were performed using statistical package for social sciences (SPSS 16.0). Results: This is a study of 102 obstetric ICU cases out of 2386 antenatal, intranatal and postnatal admissions including abortions from January 2009 to July 2010.the incidence of obstetric ICU admissions was 4.2%. Mean SOFA score on day 1 of survived patients was 9.2% and expired patients was 13.1, on day 3 mean SOFA Score of survived patients was 6.2 and expired patients was 7.7 and on day 5 mean SOFA Score of survived patients was 3.2 and expired patients was 5.3. Conclusion: The severe maternal morbidity: mortality ratio is a possible new indicator of maternal care and more accurate then mortality data alone. Currently, our top priority are mainly two from this study. Early detection and treatment of anemia and control & treatment of hypertension will reduce large number of maternal and fetal deaths. At present, we must concentrate on anemia, hypertension and medical disorders in pregnancy (CCF, Jaundice, R S dysfunction including H1N1, AIDS etc.).
Analytical Study of Patients Admitted in Obstetric Icu at Tertiary Care Centre
Journal of Evolution of medical and Dental Sciences, 2013
This work is a cross sectional study at a tertiary care centre done over a duration of one year with the aim to determine major indications and incidence of obstetric ICU admissions, to find out duration of ICU stay and determine maternal outcome. The three most common indications of Obstetric ICU admission were haemmorrhage followed by hypertensive disorders and iron deficiency anemia.The mean duration of ICU stay was 6.1 days. Maternal mortality was 6.54 % of the total obstetric patients admitted to our ICU. To conclude , establishment of dedicated obstetric ICU at tertiary care centre with knowledge , familarity, experience and expertise of an obstetrician and special team would be the best place to monitor and treat a critically ill obstetric patient which will reduce the maternal morbidity and mortality.
Aim: Obstetric emergencies are a unique challenge particularly because of its unpredictability. This study is to analyze the obstetric admissions to IRCU. Outcome in these patients is assessed. Risk stratification was done. Methods: This is a prospective study conducted over period of 1year, from January 2019-December 2019, King George Hospital, Visakhapatnam. All pregnant women and up to 42 days of postpartum who were admitted to IRCU were included. It is a tertiary care hospital with IRCU facilities not only to its own patients but also to the referrals from peripheries and other districts. Results: There were 142 obstetric admissions to IRCU accounting for 1.8% of total deliveries. 52.8% were in the age group of 20-25 years. 46.47% were in their first pregnancy. A majority of patients were admitted during postpartum period (69.71%). The leading obstetric indications for ICU admission were hypertensive disorders of pregnancy accounts for 44.3%. 12.67% of cases underwent emergency hysterectomy and 5.63% underwent emergency laparotomy. 57.04% need mechanical ventilation, 56.33 % need inotropic support. 57.7 % of individuals improved after treatment. In this study mortality was 42% of which 95% were referred from peripheries and surrounding districts in a severe morbid condition. Among the 142 obstetric admission to IRCU 85.9% were referrals. Conclusion: Common risk factors for ICU admissions are hypertensive disorders of pregnancy and obstetric hemorrhage. Other risk factors are severe anemia, heart disease, sepsis. It conclude that close follow up, early referrals of high risk pregnancies and optimal stabilization of their condition, safe transport, better education, before interventions improved the outcome of these patients.
Obstetric admissions to the intensive care unit in a tertiary referral hospital
Journal of Critical Care, 2010
Purpose: The present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome. Materials and Methods: All of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified. The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient. The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared. Results: Seventy-three obstetric patients were admitted to the ICU. There were 9 maternal deaths and 24 fetal deaths. For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients, the SAPS II score was 64 and estimated maternal mortality rate was 73%. The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates. Conclusions: Pregnancy-induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients. Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS II.
Why Do The Obstetric Patients Go To The ICU/HDU ? A Retrospective Observational Study
Care of the critically ill parturients is a unique challenge in obstetrics particularly because of its unpredictability. Antenatal period , intrapartum period and perpeurium can be complicated by aggravation of a preexisting illness, complications of the delivery-the pregnancy itself leading to severe maternal morbidity necessitating ICU/HDU admission. AIMS AND OBJECTIVES: 1) To determine the incidence of obstetric ICU admission. 2)To find out common indications of obstetric ICU/HDU admission. 3)To study the interventions required and duration of ICU stay. 4)To study the outcome of obstetric patients admitted to ICU. MATERIALS AND METHODS: It is a observational retrospective study of 65 obstetric and immediate postpartum patients , aged between 18 – 40 years admitted in obstetric ICU of NIMS hospital , Jaipur from a period between 1 st jan 2014 to 30 th jan 2015. RESULT : out of 3600 obstetric admissions during the study period , 68(1.8%) patients were admitted in ICU. The most common indication for ICU admission was obstetric haemorrhage in 27 (39.7%) patients Of which postpartum haemorrhage topped the list in 12 (17.6%) followed by ectopic in 6 (8.8%). Hypertension was seen in 11 (16.17) patients. The mean length of stay in ICU was 5.6 days. maternal mortality was 5.8% of patients admitted in ICU. CONCLUSION: obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU/HDU admission. so critically ill obstetric patients require a team approach of the obstetricians, anesthesiologists and intensivists for the optimal care and better outcome.