ICU ADMISSIONS IN OBSTETRICS: ANALYSIS OF INDICATIONS , INTERVENTIONS AND MORTALITY IN A TERTIARY CARE CENTRE. (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.
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.
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.
Profile of Patients Admitted in ICU with Obstetric Emergencies : An Observational Study
2018
DOI: 10.21276/sjams.2018.6.11.43 Abstract: Care of the critically ill obstetric patients is a unique challenge particularly because of its unpredictability. Pregnancy though physiological and can be associated with major maternal morbidity with potential catastrophic consequences requiring utilization of facilities of Intensive Care Unit (ICU). To study the profile of patients admitted in LD Tertiary Care ICU Hospital Dept of Obstetrics & Gynecology, Govt; Medical College, Srinagar. A hospital based observational study was conducted from June 2014 to June 2016. All obstetric admissions to the ICU up to 42 days postpartum were included. Detailed history taken and outcome noted. Results were subjected to statistical evaluation using SSP software. A total of 460 obstetric patients required ICU admission during the study period. This accounts for 2.83% of total hospital deliveries and 7.57% of all ICU admissions. Majority of patients (63%) were admitted during postpartum period. The lea...
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%.
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.).
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.
Journal of Medical Science And clinical Research
Sometimes complications arise during pregnancy or in the postpartum period warranting intensive care which leads to ICU admission of such patients. This was a prospective study carried out to determine the profile of maternal admissions to intensive care unit and requirement of referral to a tertiary care hospital along with maternal outcomes. The percentage of ICU admission of obstetric patients was 0.65% of total deliveries. Total mortality was 20.68%. Multi-step interventions are needed to reduce mortality of ICU admitted obstetric patients.
Why do obstetric patients go to the ICU? A 3-year-study
Medical Journal Armed Forces India, 2013
Background: Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital. Methods: A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. Results: 0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients. Conclusion: Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Obstetric ICUs have become an important part of any tertiary care obstetric hospital. There have been studies in different parts of the world including India to determine the clinical spectrum, management and outcome of the patients admitted to these units. There have been a few studies on the subject from our part of the country, so we tried to carry out the said study. Our objective was to study indications of admissions, the pattern of complications, interventions required, and the maternal and fetal /neonatal outcome of the patients admitted in an obstetric ICU of our hospital.Methods: A retrospective descriptive study carried out at Lalla Ded hospital Srinagar, a tertiary care hospital of north India, between January 2017 and June 2017.Results: Fifty patients among 4890 obstetric admissions required ICU care giving an admission rate of 1.02%. Most of the patients fell in the age group of 26-30years (52%) followed by 31-35 years (24%).The most frequent indication for...