Obstetric admissions to tertiary level intensive care unit – Prevalence, clinical characteristics and outcomes

Joseph, Chris Maria; Bhatia, Gaurav; Abraham, Valsamma; Dhar, Tapasya

doi:10.4103/ija.ija_537_18

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…The mean age group of the patients in our study was 27±5 years, comparable to other studies by Bahadur et al, Gupta et al 7,8 Majority of patients admitted to ICU were multigravida (55.2%) similar to Gupta et al and Verma et al 8,9 82.8% of patients needed ICU care in their antenatal period as compared to Joseph et al, Bhadade et al 10,11 As our hospital is a tertiary care center, 60.4% (unbooked) cases admitted to ICU were referred from other hospitals for further management as they were not well equipped to manage obstetric emergencies which is comparable to the study by Ashraf et al 12 Out of the maternal admissions to the ICU, 70.9% had predominant obstetric causes and 29.1% had non obstetric causes. Peripartum cardiomyopathy, idiopathic thrombocytopenic purpura, congenital heart disease, seizures unrelated to eclampsia constituted the majority of the non-obstetric etiologies (Table 1).…”

Section: Discussionsupporting

confidence: 88%

“…The mean duration of ICU stay was 3±3.1 days which was comparable to studies done by Joseph et al and Bahadur et al 7,10 Maternal mortality rate in our study was 2.23% with 3 deaths which is very low as compared to other studies. 4,7,10 Our patients had lower APACHE II and SOFA scores. We have dedicated high risk labor rooms for patients who show clinical signs of impending obstetric emergency.…”

Section: Discussionsupporting

confidence: 88%

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Study on clinical profile, scoring systems and outcomes of obstetric patients in our intensive care unit

Babu

Tauro²,

Menon³

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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Background: Obstetric patients in ICU, pose a clinical challenge to intensivists and obstetricians. The objective of our study was to evaluate the incidence, indications and interventions in these patients. Secondly to assess whether clinical scores can help to estimate severity of the condition, predict mortality and morbidity in these patients.Methods: It was a retrospective observational study including all antepartum and postpartum patients admitted to ICU between January 2018 to June 2020.Results: Majority of patients needing ICU care were in the antepartum period (82.8%). Multigravida (55.2%) and unbooked cases (60.4%) constituted a major proportion of patients. Hypertensive disorders of pregnancy followed by sepsis amounted for common etiologies. Transfusions (43.2%), ventilatory support (26%) followed by inotropic support (14.9%) were the interventions required in the majority number of patients. Maternal mortality rate was 2.23%. Out of the clinical scores, OEWS (Obstetric early warning score) was a better modality to assess the severity of the disease and the need for ICU care.Conclusions: A multidisciplinary approach and close coordinated care of obstetric patients can reduce the maternal mortality rate. Early identification of critically ill obstetric patients using clinical scores can help us in triaging patients to high dependency units/ICU. OEWS is a very simple score which helps us in identifying patients needing intensive care.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Study on clinical profile, scoring systems and outcomes of obstetric patients in our intensive care unit

Babu

Tauro²,

Menon³

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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“…HELLP syndrome is seen in 0.1–1% of all pregnant women and 1-2% of patients with serious preeclampsia and eclampsia. It constitutes 5.5% of obstetric patients staying in ICU [ 11 ]. In this study, it was determined that HELLP syndrome constitutes 2.4% of all births, 7.9% of patients with preeclampsia and eclampsia, and 8.3% of patients staying in ICU due to obstetric causes.…”

Section: Discussionmentioning

confidence: 99%

“…Also, it is reported that a long time stay in the intensive care unit is one of the most important factors that affect maternal mortality [ 28 ]. The average length of stay in the ICU of patients with HELLP syndrome is 3.47 (3.16) days [ 11 ]. In this study, the average length of stay in the ICU for patients with HELLP syndrome was determined as 8.1 (7.2) days.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting ICU Stay and Length of Stay in the ICU in Patients with HELLP Syndrome in a Tertiary Referral Hospital

Ağaçayak

Buğday

Peker

et al. 2022

International Journal of Hypertension

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Objective. The study aimed to compare patients with HELLP syndrome who require intensive care and who do not require intensive care and evaluate the factors affecting the length of stay in the intensive care unit. Methods. Patients were divided into two groups as follows: requiring intensive care (group 1) and not requiring intensive care (group 2). The data of both groups were compared in terms of demographic characteristics, transfusion amounts, length of stay in the intensive care unit, maternal complications, and mortality. Results. 14032 births in a tertiary center between 2011 and 2018 were evaluated in this study. During the study period, 342 patients were diagnosed with HELLP, and 32 (9.4%) of these were followed up in the intensive care unit. The length of stay in the intensive care unit was determined as 8.1 (7.2) days on average. Fresh frozen plasma, erythrocyte suspension, apheresis, and random thrombocyte transfusion were observed to be significantly more in group 1 patients. In the regression analysis, the most effective factor was found to be erythrocyte suspension and the length of stay in the intensive care unit was significantly longer in patients who had erythrocyte suspension transfusion. The receiver operating characteristic curve showed that the area under the curve value for erythrocyte transfusion was 70.6%. When the cutoff value of erythrocyte suspension was 450 (95% CI: 365–681) ml, the sensitivity was 43.8% and the specificity was 91.6%. Conclusion. We think that physicians should be careful that maternal morbidity and mortality may increase as the need for erythrocyte suspension transfusion increases in patients with HELLP syndrome. Minimum transfusion to hemodynamically stable patients can be more suitable in terms of morbidity and mortality in managing patients with HELLP syndrome requiring erythrocyte suspension transfusion. Precautions and measures should be taken in this regard.

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“…5 Risk factors of excessive bleeding after delivery include RPOC's , sepsis , hematocrit < 30% and coagulopathy . 6,7 Various drugs and surgical ( both conservative & definitive) methods have been used to combat the situation . 8 An easy and efficient measure is to stop the postpartum hemorrhage due to uterine atony , is with utero-vaginal packing as it is prompt & underlying mechanism is direct compression of site of hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Safety and Efficacy of Intrauterine Foley’s Catheter Balloon and Uterovaginal Packing in Patients with Excessive Vaginal Bleeding after Vaginal Delivery

Khalid¹,

Khan²,

Kousar³

et al. 2022

PJMHS

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Objectives: To compare the safety and efficacy of uterovaginal packing and Foley’s catheter balloon tamponade in patients with excessive vaginal bleeding following vaginal delivery. Design : RCT ( Randomized Controlled Trial). Setting : Obstetrics & Gynaecology Deptt. , HFH ( holy family hospital) , RWP. Duration: Six Months. Materials & Methodology: 94 females who presented with excessive vaginal bleeding ( > 500 ml) following vaginal delivery, 18 to 40 years of age , gestational age (GA) ≥37 weeks were included. Patients with retained products of conception, PPH due to perineal, cervical or vaginal tear and coagulation disorders were excluded. The patients were distributed equally into 2 groups ; a and b based on the lottery method. Group a was managed with uterine packing and Group b was managed by the Foley’s catheter balloon tamponade. Efficacy and safety in both groups was measured. Results: In my study, efficacy was significantly high in uterine packing group (Group a) compared to Foley’s catheter balloon tamponade (group b) (89.36% versus 68.09%; respectively) with p-value of 0.012. In my study, safety was significantly high in uterovaginal packing group (Group a) compared to Foley’s catheter balloon tamponade (group b) (72.34% versus 31.91%; respectively) with p-value of 0.0001. Conclusion: Uterovaginal packing is more secure, prompt and efficient procedure to manage excessive hemorrhage after delivery compared to Foley’s catheter balloon tamponade. Keywords: Hemorrhage, uterovaginal packing ,foley’s balloon tamponade.

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Obstetric admissions to tertiary level intensive care unit – Prevalence, clinical characteristics and outcomes

Cited by 13 publications

References 12 publications

Study on clinical profile, scoring systems and outcomes of obstetric patients in our intensive care unit

Study on clinical profile, scoring systems and outcomes of obstetric patients in our intensive care unit

Factors Affecting ICU Stay and Length of Stay in the ICU in Patients with HELLP Syndrome in a Tertiary Referral Hospital

Comparison of Safety and Efficacy of Intrauterine Foley’s Catheter Balloon and Uterovaginal Packing in Patients with Excessive Vaginal Bleeding after Vaginal Delivery

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