Predictors of mortality in critically ill obstetric patients in a tertiary care intensive care unit: A prospective 18 months study

Sodhi, Kanwalpreet; Bansal, Venus; Shrivastava, Anurag; M, Krishna Kumar; Bansal, Namita

doi:10.4103/joacc.joacc_57_17

Cited by 15 publications

(17 citation statements)

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“…Although the number of antepartum admissions was less and on par with the above studies, we observed a significant mortality among them. The mean hospital and ICU LOS (10.1 and 3.04 days respectively) of the study population were comparable to the recent studies 4,6,11,14,15 . But wide variations in the duration of ICU stay in both survivors and non survivors had been a confounding factor for this data.…”

Section: Discussionsupporting

confidence: 87%

Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India

2019

Indian Journal of Critical Care Medicine

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Background Critically ill obstetric patients represent a small proportion of intensive care unit (ICU) admissions. Physiological changes of pregnancy along with pregnancy specific diseases may lead to rapid deterioration of the health status of the parturient warranting ICU care. The present study aims to study the clinical profile and outcomes of the obstetric patients requiring ICU care. Study design and settings Prospective observational study in the multidisciplinary ICU of a tertiary care teaching hospital conducted for a period of 2 years. Materials and methods Demographic details, indication for ICU admission, severity of illness scores, interventions, complications and outcomes of the consecutive obstetric patients transferred to ICU were studied. Results Ninety-one patients were admitted (26 per 1000 deliveries) to the ICU. Majority of them were postpartum (84.6%) and unbooked or referred (63.8%). Hypertensive disorders (24.2%) and obstetric hemorrhage (23.1%) were the major cause for admission to ICU. Forty three patients (47.3%) underwent cesarean delivery. Mechanical ventilation (54.9%), blood transfusion (46%), vasopressor therapy (22%) and dialysis (9.9%) were the various interventions provided in the ICU. Patients with sepsis had high mortality accounting for one third of ICU mortality. The ICU mortality rate was 9.9%. Conclusion The present study showed a clinical profile and outcomes similar to the current scenario of critically ill obstetric patients nationwide. Further studies with a larger sample size may provide a better insight in this population. How to cite this article Sailaja B, Renuka MK, et al . Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India. Indian J of Crit Care Med 2019;23(2):78-82.

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Section: Discussionsupporting

confidence: 87%

Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India

2019

Indian Journal of Critical Care Medicine

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“…This gure is higher than what reported in cohort studies from high resources countries, where less than 5% of obstetric patients admitted to the ICU had a poor outcome (19). However it is a crude mortality rate comparable to previous investigations in India and Nigeria (6,21) that spotlight the still alarming hospital mortality of critically ill women.…”

Section: Discussionsupporting

confidence: 63%

“…Low resources countries have a disproportionally greater share of obstetric critical illness, and yet critical care facilities remain scarce. This is shown in several ICU cohort studies from Nigeria (17,20,21). In fact, while in high-resources countries around 0.9-1% of pregnant women require ICU admission, this gures may rise up to 10% in low resources countries (22).…”

Section: Discussionmentioning

confidence: 86%

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

Marotta¹,

Pisani²,

Fd³

et al. 2020

Preprint

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Background: A better understanding of the context specific epidemiology, outcomes and risk factors for death of critically ill parturients in resource-poor hospitals is needed in order to tackle the still alarming in-hospital maternal mortality in African countries.Methods: One–year retrospective cohort in a referral maternity hospital in Freetown, Sierra Leone. Primary data source was the patient chart. The primary endpoint was the association between risk factors and HDU mortality. The study was registered on ClinicalTrials.gov (study identifier NCT04121234).Results: 523 patients (median age 25 years, IQR 21-30) were admitted to the HDU for a median of 2 (IQR 1-3) days. 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week. 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were: ward rather than post–operative referrals (odds ratio (OR), 3.21 [95%-confidence interval (CI) 1.48 to 7.01]; P = 0.003), admissions with a red vs. yellow/green OEWS (OR, 3.66 [95%-CI 1.15 to 16.96]; P = 0.04), responsiveness to pain or unresponsiveness on the AVPU scale (OR, 5.25 [95%-CI 2.64 to 10.94]; P =<0.0001), use of vasopressors (OR, 3.24 [95%-CI 1.32 to 7.66]; P =0.008). Higher SpO 2 was associated with improved survival (OR, 0.95 [95%-CI 0.91 to 0.98]; P =0.007).Conclusions: Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Mortality is high and mostly occurs during first day. Medical admission, a red OEWS code, a poor neurological and hemodynamic status were independently associated with mortality, while adequate oxygenation was associated with survival.Trial Registration: The study was registered on ClinicalTrials.gov (study identifier NCT04121234).Plain English summarySierra Leone is one of the countries with the highest maternal mortality rate of the world. Understanding of critical care issues and potential interventions is lagging behind approaches in the primary care and obstetric domain. This study, reporting data from 525 patients admitted to an obstetric HDU, to date represents the largest cohort of critically–ill parturients from a low–income country. At multivariable analysis, being referred from the ward rather than being post–operative (OR 3.21, 95% CI 1.48 to 7.01), red OEWS code (OR 3.66, 95% CI 1.15 to 16.96), being responsive to pain or unresponsive on AVPU scale (OR 5.25, 95% CI 2.64 to 16.96) at admission, use of vasopressors at admission (OR 3.24, 95% CI 1.32 to 7.66) were independent risk factors for mortality, while higher SpO2 (OR 0.95, 95% CI 0.91 to 0.99) was associated with increased survival.The findings of this study can be summarized as follows (1) in a low–resource referral maternity hospital one out of 14 deliveries needed critical care attention, with a crude mortality rate of 10.5%; (2) independent predictors of mortality were poor neurological status, a red OEWS code at admission to HDU and the use of vasopressors during the stay; (3) higher oxygenation was associated with survival. Clinicians and policy makers may use these findings to prioritize simple critical care interventions to address maternal mortality in a high burden scenario.

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“…[ 6 ] APACHE II and SOFA scores have been previously reported to overpredict mortality among pregnant women. [ 7 8 9 ] This study is unique to have used the WHO NM criteria and MSS, specific to obstetric population amongst women receiving anaesthesia and those requiring post-operative critical care. The standardised approach recommended by the WHO also allows for uniform comparison across regions.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

2020

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Background and Aims: Risk stratification of severely morbid obstetric patients receiving anaesthesia services can be helpful in improving maternal outcomes. This study was undertaken to analyse these patients using the WHO near-miss (NM) approach and to assess the applicability of maternal severity score (MSS) to predict maternal mortality. Methodology: This is a one-year retrospective cohort analysis at a tertiary care centre. Of all the obstetric patients receiving anaesthesia, those with 'potentially life-threatening conditions' (PLTC) were identified. Amongst women with PLTC, those fulfilling the WHO NM criteria were grouped into either maternal near miss (MNM) or maternal death (MD) depending on final survival outcome. The MSS was assessed upon admission to post-anaesthesia ICU. The cases of “near miss” were compared to maternal death to determine the factors and WHO NM criteria significantly associated with mortality. Area under ROC curve (AUROC) was used to assess the accuracy of MSS to predict maternal mortality. Results: Of the 4351 anaesthetised obstetric patients, 301 were PLTC, 59 MNM and 11 MD. Obstetric haemorrhage was the commonest PLTC with the highest risk for MNM and MD. Preoperative organ dysfunction, referral from other centres, intra-uterine fetal death (IUFD) and WHO cardiovascular and respiratory NM criteria were significantly associated with mortality. MSS had excellent accuracy for the prediction of mortality (AUROC was 0.986 and 95% CI 0.966–0.996). Conclusion: Haemorrhage is the leading cause of MNM and MD. MSS is reliable in stratifying the severity of maternal morbidity and in predicting maternal mortality. Thus it can be used as an effective prognostic tool.

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Predictors of mortality in critically ill obstetric patients in a tertiary care intensive care unit: A prospective 18 months study

Cited by 15 publications

References 1 publication

Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India

Critically Ill Obstetric Admissions to an Intensive Care Unit: A Prospective Analysis from a Tertiary Care University Hospital in South India

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

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