Study of Obstetric Admissions to the Intensive Care Unit of a Tertiary Care Hospital (original) (raw)
Related papers
International Journal of Clinical Obstetrics and Gynaecology, 2019
To analyze obstetric admissions to intensive care unit and to identify the risk factors responsible for intensive care admission. Method: This is a retrospective study of all obstetric cases admitted to the intensive care unit over a period of 1 year. Data were collected from case records. The risk factors responsible for ICU admission were analyzed. Result: In the 12 month period from 1 January 2016 to 31 december 2016, 12828 women delivered in our hospital, with 67 maternal deaths, giving a maternal mortality ratio of 5.22/1000 deliveries. The total admissions in the obstetric ICU were 128 women (ICU utilization rate was 0.99 per 100 deliveries) with 61 (48%) survivors and 67 (52%) non-survivors. Majority of the patients belonged to 20-30 years age group (72.8%) 46.8% were primipara, 82 % were admitted in antepartum period. Most were in the gestational age between 37 and 40 weeks (38%) Obstetric hemorrhage found to be the most important antepartum risk factor (44%)after anaemia 58%.In our study ICU maternal mortality were 52%, majority of patients were referred from other peripheral centers and the majority were due to eclampsia and pre-eclampsia (58%) and postpartum hemorrhage (22%). Maternal mortality were 52%, majority of patients were referred from other peripheral centers and the majority were due to eclampsia and pre-eclampsia (58%) and postpartum hemorrhage(22%).Other disorders included jaundice 23%, puerperal sepsis 21%,ruptured uterus 14% and embolism 11%. The most important pre-existing medical complication was heart disease in 7% cases. The most common mode of delivery was cesarean section (39.7%) Obstetric hysterectomy was required in 5.1%, as a life saving procedure. The most common obstetric cause of ICU admission was obs haemorrhage (44%) of which 6 cases were complicated with disseminated intravascular coagulation. Majority required mechanical ventilation for<48 hours, (57.7%) Only 11 cases (8.5%) required for 4 days and more. Complications encountered While on Mechanical Ventilation are Multiorgan failure 6%, Pulmonary edema 4%, Renal failure 8%, Seizures 4%, Hepatic failure 6%, Deep-vein thrombosis 2%.
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%.
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.
Obstetric admissions to the intensive care unit
Obstetrics and Gynecology, 1999
Objective: To determine whether obstetric admissions to the intensive care unit (ICU) are useful quality-assurance indicators.Methods: We analyzed retrospectively obstetric ICU admissions at two tertiary care centers from 1991 to 1997.Results: The 131 obstetric admissions represented 0.3% of all deliveries. The majority (78%) of women were admitted to the ICU postpartum. Obstetric hemorrhage (26%) and hypertension (21%) were the two most common reasons for admission. Together with cardiac disease, respiratory disorders, and infection, they accounted for more than 80% of all admissions. Preexisting medical conditions were present in 38% of all admissions. The median Acute Physiology and Chronic Health Evaluation II score was 8.5. The predicted mortality rate for the group was 10.0%, and the actual mortality rate was 2.3%.Conclusion: The most common precipitants of ICU admission were obstetric hemorrhage and uncontrolled hypertension. Improved management strategies for these problems may significantly reduce major maternal morbidity.
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.
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.
Non-haemorrhagic causes of obstetrical intensive care unit admissions in tertiary care setting
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Management of critically ill obstetric patients involve intensive monitoring in intensive care unit. In present scenario there are significant number of obstetric patients with sepsis, tropical diseases and medical illness that require ICU care. The aim of this study was to evaluate in more detail the non-haemorrhagic causes of obstetric ICU admissions and to identify and adopt high risk strategies as prime learning objective.Methods: It is a prospective ongoing study conducted in 50 patients in SGRDUHS, Amritsar from December 2016 to October 2019, who were admitted in obstetric ICU, out of them 30 cases were attributed to non-haemorrhagic obstetric causes. All demographic parameters along with gestational age, diagnosis on admission, intervention done prior to shift to ICU and details of treatment given in ICU were evaluated. Patient outcome, review of mortality and area of improvement were also noted.Results: Majority of the patient (70.1%) were admitted in 3rd trimest...
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.
Critically ill obstetric admissions into a tertiary hospital's intensive care unit
2015
Background: Intensive Care Unit (ICU) management is a critical care and may be lifesaving in critically ill obstetric patients, but mortality remains high in low-resource countries. Objective: To review obstetric admissions into a tertiary hospital ICU. Design: Retrospective descriptive study. Setting: The ICU of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Subjects: Women admitted to the ICU during pregnancy or within 42 days of the end of the pregnancy. Materials and Methods: A list of all eligible participants was compiled, the case files were retrieved and relevant data extracted; the results were presented in tables and percentages. Results : Obstetric patients constituted 12.3% of the total ICU admissions and 0.84% of all deliveries with 45.6% mortality; the mean age was 29.2 ± 5.4 years (range 18–42 years), mean parity was 2.0 ± 1.5 (range 0–6), 15 (28.8%) had no formal education, 39 (75.0%) were of low social class, 22 (42.3%) had no antenatal care, 41 (78.9%...