Near-Miss Incidents in Obstetric Patients Admitted to an Intensive Care Unit of a Tertiary Care Center in Eastern India: A Retrospective Cohort Study

Abstract

Aim Obstetric patients presenting to the intensive care units (ICU) with or without underlying medical or surgical comorbidities can be a challenge to both the treating obstetrician and the intensivist. They occasionally present with near-miss events which if left untreated, can result in death. Objectives To study the prevalence, indications of ICU admissions, near-miss events, and their effect on mortality in obstetric and puerperal patients . Material & methods We conducted a retrospective analysis of the health records of all the obstetric and puerperal patients (pregnant and until 6 weeks postpartum) admitted to our tertiary care hospital from January 2019 to December 2020. Patient demographic characteristics, obstetric, surgical, and medical conditions, acute physiology, and chronic health evaluation (APACHE) II scores, organ failures, treatment, ICU and hospital length of stay, and mortality outcomes were studied. Results A total of 22 obstetric patients were admitted to the ICU during the above study period. Mean age was 28.7 ± 6.24 years, mean gestation was 34.4 ± 6.61 weeks, mean APACHE II score was 12.68 ± 5.67, median ICU length of stay was 5 days, and median duration of hospital length of stay was 10 days. The antepartum risk factors such as severe preeclampsia (27%), antepartum bleeding (14%), and postpartum complications like postpartum haemorrhage (33%), sepsis with multiorgan failure (25%) are the commonest indications that resulted in ICU admission. Conclusion Higher APACHE II scores at the time of ICU admission, prolonged ICU, and hospital length of stay may be associated with high maternal mortality.

Atención oportuna en minimizar la morbilidad y la mortalidad asociadas a la hemorragia posparto

“…En la investigación de 13 se menciona que en la Unidad de Cuidados Intensivos (UCI) el manejo de esta condición médica comprende la monitorización cardiaca por electrodos, pulsioximetría, presión arterial no invasiva, temperatura, diuresis, presiones venosas centrales y presiones arteriales invasivas. Una medida importante a tomar también es la gasometría arterial que debe realizarse dos veces al día y luego según lo requiriera la situación clínica.…”

Analysis of maternal near miss cases in a tertiary care hospital

“…Kumar et al study showed 7:1, whereas Roopa et al study showed 5.6:1. 15,19 If this maternal near miss indices shows positive deflection over period of time, it reflects on the improvement achieved in obstetric care.…”