Study of outcome of obstetric emergencies admitted to intensive care unit

Bahadur, Badugu Rao; Kodey, Prabhadevi; Tanniru, Jeevitha; Tirumala, Suhasini

doi:10.18203/2320-1770.ijrcog20182905

Cited by 4 publications

(7 citation statements)

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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: 91%

“…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%

“…Maternal admissions into the ICU constituted about 3.3% of overall ICU admissions and 1.7% of total deliveries in the 30 months of study period compared to 1.29% of all deliveries in the study by Bahadur et al, 0.8% of all deliveries in the study by Verma et al and 0.14% by Gupta et al [6][7][8][9] The higher rate of ICU admissions of obstetric patients in our study could be due to the presence of renowned obstetricians in our center and the significant number of patients coming for obstetric care. Since our hospital is a tertiary care referral center, complicated obstetric cases are referred to us for multidisciplinary care.…”

Section: Discussionmentioning

confidence: 80%

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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: 91%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 80%

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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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“…Mortality rates following obstetric ICU admission of 34.8%-49% have been reported in sub-Saharan Africa [2,6,10] compared to 5.1% in China and <1% in Australia and New Zealand [11,14]. A mean duration of stay of 3-4 days has been reported in Asia and Europe [12,15] and hypertensive disorders of pregnancy (HDP), hemorrhage, and sepsis are often the main indications for ICU admission [1,2,6].…”

Section: Plos Onementioning

confidence: 99%

A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country

et al. 2021

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Introduction Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. Methods This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. Results There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. Conclusion Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. Plain language summary This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.

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“…In one retrospective analytical study in 2014, Ashraf et al 7 reported obstetric hemorrhage as a cause of ICU admission in 51% cases and pregnancy-related hypertension in 11% cases. A few years later in 2018, Bahadur et al 8 reported obstetric hemorrhage cases in ICU to be 38.6% and those of hypertensive disorders of pregnancy to be 28.6%. In another recent analytical study of obstetric ICU admissions in 2019, Veerabhadrappa et al 9 reported proportions of obstetric hemorrhage and hypertensive disorders of pregnancy to be 30 and 33.3%, respectively.…”

Section: Linical P Rofile Of the mentioning

confidence: 99%

Critically Ill Obstetric Patients and Fetomaternal Outcome

Bande

2020

Indian Journal of Critical Care Medicine

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A bstract Reduction in the maternal mortality ratio (MMR) continues to be a worldwide challenge. With repeated analytical studies done over decades, it has become possible to identify the significant contributors to this challenge. Right from low socioeconomic status to the availability of recent technological advances, many factors need attention and prioritization. Obstetric hemorrhage remains an important cause followed by hypertensive disorders of pregnancy and sepsis. In this issue of IJCCM, Miglani et al. have highlighted the various levels of the delays, which are significant contributors to the high MMR. In other preventive strategies, efforts will be needed to improve patient education, infrastructure, availability of trained manpower, blood storage facilities, timely referrals, transport facilities, etc., at peripheral levels. In the tertiary care centers, there is an increased need for trained manpower in critical care, the obstetric medical emergency team as a new concept, aggressive teamwork in intensive care unit (ICU) and operation theaters, the use of advanced technologies and newer drugs, etc. It will remain a tough challenge to reduce global MMR to 70 per 100,000 live births, as per plans by the United Nations, by the year 2030. How to cite this article Bande BD. Critically Ill Obstetric Patients and Fetomaternal Outcome. Indian J Crit Care Med 2020;24(11):1005–1007.

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Study of outcome of obstetric emergencies admitted to intensive care unit

Cited by 4 publications

References 15 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

A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country

Critically Ill Obstetric Patients and Fetomaternal Outcome

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