Background: The goals of management of critically ill obstetric patients involve intensive monitoring and physiological support for patients with life threatening but potentially reversible conditions. Intensive care unit (ICU) is highly specified and sophisticated area of a hospital which is specifically designed, staffed, located, furnished, and equipped, dedicated to the management of critically sick patient, injuries, or complications. The aim of this study is to know the frequency of ICU admissions, to analyze the disease comorbidity related to medical and obstetrical problems, to segregate cause of morbidity, and also to identify and adopt risk reduction strategies.
Methods: This observational study was conducted on 35 ICU patients in our institute from 1 December 2016 to 31 May 2018. Our study was divided into two groups. In group I, the intervention was done first followed by ICU intervention and, in group II, ICU stabilization was done prior to surgical intervention. The parameters noted were age, parity, diagnosis on admission, and associated medical and surgical comorbidity; reason for ICU admission, any surgical procedure performed, antenatal, and postnatal admission; details of treatment given like ventilator support, blood and blood components' transfusion, inotropic support, and dialysis. Neonatal outcome was also noted and the total duration was noted. Parameters noted after ICU admissions were cost, duration of stay, patient outcome, review of mortality, and area of improvement.
Results: There were 17.1% of mortalities observed in our study. The commonest cause for maternal mortality was multi-organ dysfunction (33.3%) followed by hypertensive disorder of pregnancy (16.7%), peripartum cardiomyopathy (16.7%), acute fatty liver of pregnancy (16.7%), and septic shock (16.7%). Severe anemia, cardiac diseases, sepsis, need for a caesarean delivery, and more than one diagnosis on admission are the other risk factors for ICU admission.
Conclusion: The majority of the survivors (69%) were discharged satisfactorily from the hospital. There is a need for training in emergency obstetrics so that the complication can be managed right at the time of occurrence. There is a need to train obstetricians in obstetric medicine and critical care to do justice to these critically ill pregnant women.
Harmer M. Maternal mortality – is it still relevant? Anaesthesia 1997;52:99-100.
Ananth CV. Epidemiology of critical illnesses and outcomes in pregnancy. In: Belfort MA, Dildy GA, Saade GR, et al. ed. Critical Care Obstetrics. 4th ed. Boston: Blackwell Publishing Ltd, 2004; p.11.
Sadler LC, Austin DM, Masson VL, 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-e7. doi: 10.1016/j.ajog.2013.07.031.
Ibrahim IA, Rayis DA, Alsammani MA, et al. Obstetric and gynecologic admissions to the intensive care unit at Khartoum Hospital, Sudan. Int J Gynecol Obstet 2015;129(1):84. doi: 10.1016/j.ijgo.2014.10.019.
Wanderer JP, Leffert LR, Mhyre JM, et al. Epidemiology of obstetric-related ICU admissions in Maryland: 1999–2008. Crit Care Med 2013;41(8):1844-1852. doi: 10.1097/ CCM.0b013e31828a3e24.
Bandeira AR, Rezende CA, Reis ZS, et al. Epidemiologic profile, survival, and maternal prognosis factors among women at an obstetric intensive care unit. Int J Gynaecol Obstet 2014;124(1):63-66. doi: 10.1016/j.ijgo.2013.07.015.
Baskett TF, O'Connell CM. Maternal critical care in obstetrics. J Obstet Gynaecol Can 2009;31(3):218-221. doi: 10.1016/ S1701-2163(16)34119-6.
Small MJ, James AH, Kershaw T, et al. Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions. Obstet Gynecol 2012;119:250-255. doi: 10.1097/AOG.0b013e31824265c7.
Al-Suleiman SA, Qutub HO, Rahman J, et al. Obstetric admissions to obstetric ICU-a 12 year review. Arch Gynecol Obstet 2006;274:4. doi: 10.1007/s00404-004-0721-z.
Mabie WC, Sibai BM. Treatment in an obstetric intensive care unit. Am J Obstet Gynecol 1990;162:1-4.
Rochat RW, Kooniar LM, Atrash HK, et al. Maternal mortality in USA. Obstet Gynecol 1988;72(1):91-97.
Rathod AT, Malini KV. Study of obstetric admissions to the intensive care unit of a tertiary care hospital. J Obstet Gynaecol India 2016;66(Suppl 1):12-17. doi: 10.1007/s13224-015-0750-5.
Bhadade R, de Souza R, More A, et al. Maternal outcomes in critically ill obstetrics patients: a unique challenge. Indian J Crit Care Med 2012;16:8-16. doi: 10.4103/0972-5229.94416.
Jain S, Guleria K, Vaid NB, et al. Predictors and outcome of obstetric admissions to intensive care unit: a comparative study. Indian J Public Health 2016;60:159-163. doi: 10.4103/0019-557X.184575.
Keizer JL, Zwart JJ, Meerman RH, et al. Obstetric intensive care admissions: a 12year review in a tertiary care centre. Eur J Obstet Gynecol Reprod Biol 2006;128:152-156. doi: 10.1016/j. ejogrb.2005.12.013.
Zwart JJ, Dupuis JR, Richters A, et al. Obstetric intensive care unit admission: a 2year nationwide population-based cohort study. Intensive Care Med 2010;36:256-263. doi: 10.1007/ s00134-009-1707-x.
Vasquez DN, Estenssoro E, Canales HS, et al. Clinical characteristics and outcomes of obstetrics patients requiring ICU admission. Chest 2007;131:718-724. doi: 10.1378/chest.06-2388.
Neto AFO, Parpinelli MA, Cecatti JG. Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity. Int J Gynaecol Obstet 2009;105(3):252-256. doi: 10.1016/j.ijgo.2009.01.025.
Karnad DR, Lapsia V, Krishnan A, et al. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med 2004;32:1294-1299.