Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit

Murki, Anuradha; Dhope, Sheetal; Kamineni, Vasundhara

doi:10.1080/14767058.2016.1178229

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…The research showed a rising trend of high-risk pregnancies in our population, which resulted in an increased demand for higher level of care. The rate of HDU admission in this study was 7.1%, which was higher than the UK survey (4.2%) [ 8 ] and lower than two single center reports from India (11.1 and 11.2%) [ 9 , 10 ]. The variations were likely to be influenced by annual birth rate, characteristics of the population, and criteria for transferring women to ICU.…”

Section: Discussioncontrasting

confidence: 80%

Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit

Zheng

Dai

2022

BMC Pregnancy Childbirth

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Background To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU). Methods This is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU in a provincial referral center in China from January 2014 to December 2019. The collected information included maternal demographic characteristics, indications for ICU and HDU admission, the length of ICU stay, the total length of in-hospital stay and APACHE II score. Chi-square and ANOVA tests were used to determine statistical significance. The temporal changes were assessed with chi-square test for linear trend. Results A total of 40,412 women delivered and 447 (1.11%) women were admitted to ICU in this 6-year period. The rate of ICU admission peaked at 1.59% in 2016 and then dropped to 0.67% in 2019 with the introduction of obstetric HDU. The average APACHE II score increased significantly from 6.8 to 12.3 (P < 0.001) and the average length of ICU stay increased from 1.7 to 7.1 days (P < 0.001). The main indications for maternal ICU admissions were hypertensive disorders in pregnancy (39.8%), cardiac diseases (24.8%), and other medical disorders (21.5%); while the most common reasons for referring to HDU were hypertensive disorders of pregnancy (46.5%) and obstetric hemorrhage (43.0%). The establishment of HDU led to 20% reduction in ICU admission, which was mainly related to obstetric indications. Conclusions The introduction of HDU helps to reduce ICU utilization in obstetric population.

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Section: Discussioncontrasting

confidence: 80%

Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit

Zheng

Dai

2022

BMC Pregnancy Childbirth

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“…The variations were likely to be in uenced by annual birth rate, characteristics of the population, and criteria for transferring women to ICU. Similar to the literatures [9][10], which showed the main indications for high dependency care were obstetric reasons, our research found that 46.5% of women were admitted for hypertensive disorders and 43.0% were for obstetric hemorrhage, as most women with severe obstetric complication might require close support and monitoring instead of invasive treatment such as mechanical ventilation.…”

Section: Discussionsupporting

confidence: 88%

“…It is notable that, after the establishment of HDU, there was a shift of women with obstetric complications to HDU, while women with severe medical co-morbidities were still referred to ICU. The rate of HDU admission in this study was 7.1%, which was higher than the UK survey (4.2%) [8] and lower than two single center reports from India (11.1% and 11.2%) [9][10]. The variations were likely to be in uenced by annual birth rate, characteristics of the population, and criteria for transferring women to ICU.…”

Section: Discussioncontrasting

confidence: 70%

Severe Maternal Morbidity: Admission Shift From Intensive Care Unit to Obstetric High-dependency Unit

Zheng

Dai

2021

Preprint

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Background: To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU).Methods: This is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU in a provincial referral center in China from January 2014 to December 2019. The collected information included maternal demographic characteristics, indications for ICU and HDU admission, the length of ICU stay, the total length of in-hospital stay and APACHE II score. Chi-square and ANOVA tests were used to determine statistical significance. The temporal changes were assessed with chi-square test for linear trend.Results: A total of 40 412 women delivered and 447 (11.1‰) women were admitted to ICU in this 6-year period. The rate of ICU admission peaked at 15.9‰ in 2016 and then dropped to 6.7‰ in 2019 with the introduction of obstetric HDU. The average APACHE II score increased significantly from 6.8 to 12.3 (P<0.001) and the average length of ICU stay increased from 1.7 to 7.1 days (P<0.001). The main indications for maternal ICU admissions were hypertensive disorders in pregnancy (39.8%), cardiac disease (24.8%), and other medical disorders (21.5%); while the most common reasons for referring to HDU were hypertensive disorders of pregnancy (46.5%) and obstetric hemorrhage (43.0%). After adjusting for the proportion of high-risk pregnancies, the establishment of HDU reduced 20% of ICU admission (aOR = 0.804, 95% CI =0.666-0.972).Conclusions: The introduction of HDU helps to reduce ICU utilization in obstetric population.

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“…Maternal complications explain many severe fetal morbidities and mortalities during delivery, and thus appropriate and timely management of these complications has the potential to avoid many adverse fetal outcomes . The large disparity in stillbirth rates seen in maternal near‐miss cases across different countries, from 3.8% in Finland to as high as 46% in low‐ to middle‐income countries, is probably attributable to substandard management of complications. However, measurement challenges prevail in low‐resource settings, restricting a direct comparisons of rates across different settings.…”

Section: Introductionmentioning

confidence: 99%

“…in low-to middle-income countries, [10][11][12][13][14] is probably attributable to substandard management of complications. However, measurement challenges prevail in low-resource settings, 15 restricting a direct comparisons of rates across different settings.…”

Section: Introductionmentioning

confidence: 99%

Disentangling the contributions of maternal and fetal factors to estimate stillbirth risks for intrapartum adverse events in Tanzania and Uganda

Hirose

Alwy

Atuhairwe

et al. 2018

Intl J Gynecology & Obste

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Objective To estimate the stillbirth risk associated with intrapartum adverse events, controlling for fetal and maternal factors. Methods The present study was an analysis of cross‐sectional patient‐record and facility‐file data from women with viable fetuses who experienced obstetric adverse events at 23 hospitals and 38 health centers in Tanzania (between December 2015 and October 2016), and 22 hospitals, 16 level‐4 health centers, and five level‐3 health centers in Uganda (between May 2016 and September 2017). Adverse events were categorized in three severity groups (postpartum, intrapartum non‐near‐miss, and intrapartum near‐miss) to calculate stillbirth rates and adjusted prevalence ratios. Results Data from 3816 women in Tanzania and 8305 in Uganda were included. Compared with postpartum adverse events, intrapartum near‐miss was associated with a 3.73‐ and 4.55‐fold higher prevalence of stillbirth in Uganda and Tanzania, respectively. Most women who experienced near‐miss had organ dysfunction on arrival or developed it soon after. The risk of stillbirth was higher among preterm deliveries compared with term deliveries, and was 42% and 59% lower in Tanzania and Uganda, respectively, for cesarean deliveries compared with vaginal deliveries after intrapartum non‐near‐miss adverse events. Conclusion Stillbirth risk increased with severity of complications and was higher among premature deliveries. Survival was higher for cesarean deliveries in intrapartum non‐near‐miss complications, identifying the opportunity to prevent deterioration by timely actions.

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Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit

Abstract: In the presence of standardized OHDU and an ICU, the feto-maternal outcomes of women with PLTC and near miss event are similar to those without near miss events.

Cited by 5 publications

References 4 publications

Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit

Severe maternal morbidity: admission shift from intensive care unit to obstetric high-dependency unit

Severe Maternal Morbidity: Admission Shift From Intensive Care Unit to Obstetric High-dependency Unit

Disentangling the contributions of maternal and fetal factors to estimate stillbirth risks for intrapartum adverse events in Tanzania and Uganda

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