Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan

Abstract

ObjectiveReview of obstetric cases admitted to the intensive care unit.DesignTen year retrospective review of individual patients' medical records.ParticipantsRecords of obstetric patients admitted from 2005–2014.SettingAga Khan University Hospital KarachiMain Outcome measuresDiagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.FindingsA total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay was 24 hours and maximum stay was 53 days. Sixty one percent of patients were admitted to with organ system failure. The overall mortality rate was 21.64% (42/194). The mortality rate was five times more likely in patients who had gastro-intestinal complication {Odds Ratio=4.87; 95%CI: 1.65-14.36}. The largest group of patients {28.4%} presented with hematological diagnosis.ConclusionWhen the intensive care unit admission became essential, primary diagnosis included: postpartum hemorrhage, hypertensive disorders, sepsis and infectious diseases. An increased vigilance of high-risk pregnant women and a stabilization of their condition before intervention is administered, improves the outcome of these women.

Clinical profile and outcomes of obstetric patients requiring intensive care: An audit of patients admitted to a tertiary care hospital in Riyadh, Saudi Arabia

“…In a study by Leung et al, the mode of admission was elective in 12% and emergency in 88% patients (Leung et al, 2010). Qureshi et al reported, the source of admission was the emergency department in 38.14% and obstetrics and gynecology department in 61.85% patients (Qureshi et al, 2016). Although, our SICU is a tertiary care unit, which receives referrals from other hospitals, there was no outside referral during the said study period.…”

“…Septic shock and anesthesia complication were the causes in 12.3% and 2.9% patients in a study by Verma and Rathore (2014). In a study by Qureshi et al (2016), septic shock and anesthesia complication were seen in 56% and 4.2% patients, respectively. Whereas, septic shock was seen in 2.94% of patients in a study by Sharma et al (2016).…”

“…The mean age of our patients 34.34 ±5.63 years was high as compared to other studies. The mean age of patients in other studies ranged between 25-34 years (19-22) (Leung et al, 2010;Motiang, 2017;Verma and Rathore, 2014;Qureshi et al, 2016;Mowafy and Mashhour, 2010). In our study the mean height, weight and BMI were 158.38±7.42cm, 77.16±13.27 Kg and 30.82±5.30 Kg/m 2 , respectively.…”

“…Obstetric hemorrhage 56.16% and hypertension 19.8% were also common causes in the study by Verma and Rathore (2014). Qureshi et al (2016) found that obstetric hemorrhage and hypertensive disease of pregnancy were seen in 41% and 17.5% patients, while Sharma et al (2016) stated that hemorrhage was the commonest cause 39.7% followed by hypertension 16.17%. However, Sujata et al (2016) found that hypertension was the most common indication of SICU admission 28% followed by obstetric hemorrhage 20%.…”

“…This variation in frequency of SICU admissions may be attributed to many factors like socioeconomic status, geographical areas, referral systems, and hospital policies and protocols of admission. Several authors in the literature have previously described the causes of SICU admission in gynecological and obstetrical patients and there was differences in the results because of socioeconomic and cultural variations (Leung et al, 2010;Motiang, 2017;Verma and Rathore, 2014;Qureshi et al, 2016;Mowafy and Mashhour, 2010).…”