A retrospective analysis of obstetric patient's outcome in intensive care unit of a tertiary care center

Satinder Gombar, Vanita Ahuja, Anudeep Jafra, Satinder Gombar, Vanita Ahuja, Anudeep Jafra

Abstract

Background and aims: Admission to an intensive care unit (ICU) is considered as an objective marker of severe maternal morbidity. The aim was to assess the incidence and possible risk factors of obstetric patient admissions in the multidisciplinary ICU of a tertiary care center with emphasis on standardized mortality ratio (SMR).

Material and methods: A retrospective five year ICU record analysis was done for all pregnant women, who were admitted to multidisciplinary ICU of a tertiary care hospital during June 2007-12.

Results: During this 5-year period, 21,943 deliveries took place and 164 women required ICU admission. Out of these, the data of 151 patients were analyzed. Maternal mortality rate was 31.1% (47 deaths) for patients admitted to ICU. The simplified acute physiologic score (SAPS) II was 62 (55-68) in nonsurvivor versus 34.00 (28-46) in survivor group (P value < 0.001). The receiver operated characteristic curve was plotted using SAPS II scores and the area under the curve was 0.93 with 95% confidence interval (0.89-0.96). The calculated SMR was 0.97.

Conclusions: Women admitted to ICU with diagnosis of puerperal sepsis and intrauterine death (IUD) with coexisting sepsis had higher mortality as compared to women with hypertensive disease of pregnancy and hemorrhage. The calculated SMR was less than one which is a predictor of good ICU care.

Keywords: Developing countries; ICU; IUD; SAPS II; obstetric; obstetric hemorrhage; preeclampsia; pregnancy; puerperal sepsis.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Receiver operated curve plotted using simplified acute physiologic score II scores of 151 obstetric patients admitted in intensive care unit of a tertiary care hospital over 5-year-period

References

    1. UN Population Fund (UNFPA), World Health Organization, UN Children's Fund and the World Bank (2012) Maternal Deaths Halved in 20 Years, but Faster Progress Needed. [Last accessed on 2012 Nov 7]. Available from .
    1. Lassi ZS, Haider BA, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and improving neonatal outcomes. Cochrane Database Syst Rev. 2010:CD007754.
    1. Ensor T, Cooper S. Overcoming barriers to health service access: Influencing the demand side. Health Policy Plan. 2004;19:69–79.
    1. Singh P, Pandey A, Aggarwal A. House-to-house survey vs. snowball technique for capturing maternal deaths in India: A search for cost-effective method. Indian J Med Res. 2007;125:550–6.
    1. Bhardwaj N, Hasan SB, Zaheer M. Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study. Indian Pediatr. 1995;32:416–23.
    1. Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: A systematic review. Intensive Care Med. 2010;36:1465–74.
    1. Gilbert TT, Smulian JC, Martin AA, Ananth CV, Scorza W, Scardella AT Critical Care Obstetric Team. Obstetric admissions to the intensive care unit: Outcomes and severity of illness. Obstet Gynecol. 2003;102:897–903.
    1. Aegerter P, Boumendil A, Retbi A, Minvielle E, Dervaux B, Guidet B. SAPS II revisited. Intensive Care Med. 2005;31:416–23.
    1. Zwart JJ, Dupuis JR, Richters A, Ory F, van Roosmalen J. Obstetric intensive care unit admission: A 2-year nationwide population-based cohort study. Intensive Care Med. 2010;36:256–63.
    1. Togal T, Yucel N, Gedik E, Gulhas N, Toprak HI, Ersoy MO. Obstetric admissions to the intensive care unit in a tertiary referral hospital. J Crit Care. 2010;25:628–33.
    1. Gupta S, Naithani U, Doshi V, Bhargava V, Vijay BS. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit. Indian J Anaesth. 2011;55:146–53.
    1. Crozier TM, Wallace EM. Obstetric admissions to an integrated general intensive care unit in a quaternary maternity facility. Aust N Z J Obstet Gynaecol. 2011;51:233–8.
    1. Tempe A, Wadhwa L, Gupta S, Bansal S, Satyanarayana L. Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions. Indian J Med Sci. 2007;61:179–85.
    1. Olarra J, Longarela AM, Suarez L, Palacio FJ. Critically ill obstetric patients treated in an ICU. Chest. 2002;121:2077.
    1. Tripathi R, Rathore AM, Saran S. Intensive care for critically ill obstetric patients. Int J Gynaecol Obstet. 2000;68:257–8.
    1. Karnad DR, Lapsia V, Krishnan A, Salvi VS. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med. 2004;32:1294–9.
    1. Lapinsky SE, Hallett D, Collop N, Drover J, Lavercombe P, Leeman M, et al. Evaluation of standard and modified severity of illness scores in the obstetric patient. J Crit Care. 2011;26:535.e1–7.
    1. Munnar U, Karnad DR, Bandi VD, Lapsia V, Suresh MS, Ramshesh P, et al. Critically ill obstetrics patients in an American and an Indian public hospital: Comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes. Intensive Care Med. 2005;31:1087–94.
    1. Martey JO, Djan JO, Twum S, Browne EN, Opoku SA. Maternal mortality and related factors in Ejisu District, Ghana. East Afr Med J. 1994;71:656–60.
    1. Khumanthem PD, Chanam MS, Samjetshabam RD. Maternal mortality and its causes in a tertiary center. J Obstet Gynecol India. 2012;62:168–71.
    1. Bamfo JE. Managing the risks of sepsis in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27:583–95.
    1. Acosta CD, Knight M. Sepsis and maternal mortality. Curr Opin Obstet Gynecol. 2013;25:109–16.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner