Obstetric Patients Requiring Intensive Care: A One Year Retrospective Study in a Tertiary Care Institute in India

Background and Objectives. Critically ill obstetric patients are a particularly unique cohort for the intensivist. The objective of this study was to review the indications for admission, demographics, clinical characteristics, and outcomes of obstetric patients admitted to intensive care unit of a medical college hospital in southern India and to identify conditions associated with maternal mortality. Design. Retrospective analysis of pregnant/postpartum (up to 6 weeks) admissions over a 1-year result. We studied 55 patients constituting 11.6% of mixed ICU admissions during the study period. Results. The mean APACHE (acute physiology and chronic health evaluation) II score of patients at admission was 11.8. Most of the patients (76%) were admitted in the antepartum period. The commonest indications for ICU admission were obstetric haemorrhage (51%) and hypertensive disorders of pregnancy (18%). 85% of patients required mechanical ventilation and 78% required inotropic support. Conclusions. Maternal mortality was 13%, and the majority of the deaths were due to disseminated intravascular coagulation and multiorgan failure, following an obstetric haemorrhage. A dedicated obstetric ICU in tertiary hospitals can ensure that there is no delay in patient management and intensive care can be instituted at the earliest. 1. Introduction Obstetric patients are a particularly unique cohort for the intensivist. These patients are young and otherwise healthy; their management is challenged by concerns for fetal viability, altered maternal physiology, and diseases specific to pregnancy. There are several reports on critically ill obstetric patients, but data from India is scarce despite huge number and wide stratum of obstetric population [1, 2]. The present data was collected to understand the elements influencing the maternal outcome and identify preventable factors amongst them that were responsible for adverse maternal/fetal outcome in underdeveloped regions. The objectives of our study were to review the indications for admission, demographics, clinical characteristics, and outcomes of obstetric patients admitted in our ICU in the last one year and to identify conditions associated with maternal mortality. 2. Materials and Methods The present study was conducted in a 6-bedded multidisciplinary intensive care unit (ICU) at 1500 bedded tertiary care center, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in Pondicherry, India. Obstetric service of the hospital provides antenatal care for 110,000 out-patients and 20,000 in-patients