International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Bendre KR et al. Int J Reprod Contracept Obstet Gynecol. 2015 Apr;4(2):370-372

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: 10.5455/2320-1770.ijrcog20150416
Research Article

Critically ill obstetric patients

Kirti Rajesh Bendre*, Tanvi Vijay Tuteja, Geeta Madhav Niyogi

Department of Obstetrics & Gynecology, K.J. Somaiya Medical College and Research Centre, Mumbai, MS, India

Received: 21 January 2015

Accepted: 16 February 2015

*Correspondence:
Dr. Kirti Rajesh Bendre,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Objectives: To review all obstetric patients admitted in Intensive Care Unit (ICU) to access ethiology,
required interventions, maternal mortality and to identify the conditions associated with maternal death.
Methods: This is a retrospective study carried out in a medical college with tertiary hospital facility in Mumbai. The
ICU admissions for a period of 5 years from October 2005 to October 2010 were reviewed.
Results: Over 5 years, 48 out of 10800 obstetric patients were admitted in ICU (0.4%). Most common reasons for
admissions were obstetric hemorrhage and preeclampsia. The most common intervention done was transfusion of
blood and blood products.
Conclusions: We need better information about high risk obstetrics in order to improve maternal care. The study
identifies the risk factors for maternal mortality and severe maternal morbidity, most significant being obstetric
hemorrhage. Lack of antenatal care and delay in referral to intensive care unit adversely affect the maternal outcome.

Keywords: Intensive care unit, Obstetrics

INTRODUCTION This retrospective study was undertaken in a tertiary

teaching hospital for a period of 5 years with the aims
Care of a critically ill pregnant woman presents a unique and objectives of assessing the ethiology, spectrum of
challenge as the patient’s disease and therapy disease and interventions required for patients requiring
simultaneously affects two individuals with vastly critical care and to identify the causes of maternal
different physiologies. It is estimated that approximately mortality.
0.7-0.8% of all pregnant women will develop conditions
that would require admission in Intensive Care Unit METHODS
(ICU).1 In India 80000 women lose their lives during the
reproductive years with the maternal mortality reaching This study was undertaken in the department of obstetrics
an appaling high figure of 190 deaths per 100000 live and gynecology at a tertiary care hospital and medical
births2,3 and many of these women require specialised college with prior approval from hospital ethics
care which cannot be provided in general ward.4 The committee and anonymity of patients was preserved. In
common causes of maternal mortality are anaemia, this 5 year retrospective study from October 2005 to
hemorrhage, sepsis and toxaemia of pregnancy. Care of October 2010; 45 pregnant women who were admitted to
these critically ill obstetric patients is a task as these are ICU during pregnancy irrespective of gestational age and
women who are prone to develop multiorgan failure. within 42 days after delivery were included. Records of
Management of such women in a well-equipped ICU these cases were reviewed for details like age, parity,
improves maternal survival, reducing the mortality to a reasons for ICU admission, antepartum/postpartum, pre-
considerable extent. existing medical disease, medical interventions required,

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 Bendre KR et al. Int J Reprod Contracept Obstet Gynecol. 2015 Apr;4(2):370-372

duration of ICU stay, maternal outcome after ICU care, Obstetric hemorrhage was the commonest indication for
mortality and reason for mortality. ICU admission; being present in 19 patients (42.2%). 15
women (33.3%) were shifted to ICU for hypertensive
RESULTS disorders, 6 (13.3%) for intrauterine fetal demise and
disseminated intravascular coagulopathy, 3 patients
In 5 years there were 9023 obstetric admissions of which (6.6%) for puerperial sepsis, 3 (6.6%) for malaria, 2
45 (0.4%) women were admitted to ICU. This amounted (4.4%) for complications of tuberculosis and 1 (2.2%) for
to 1.5 % of all hospital ICU admissions. Of the 45 ARDS and multiorgan failure (Table 1).
admissions; 18 (40%) were emergency referrals and 27
(60%) were booked with our hospital (Figure 1). Table 1: Cause of ICU admissions.

07 (15.5%) were antepartum, 01(2.2%) were post abortal No. of

Cause %
and 37 (82.2%) were postpartum (Figure 2). patients
Obstetric hemorrhage 19 42.2
Hypertensive disorders 15 33.3
IUFD & DIC 06 13.3
Sepsis 03 6.6
Malaria 03 6.6
Emerg referral
Booked Tuberculosis 02 4.4
ARDS & multiorgan failure 01 2.2

11 patients (24.4% ) of women admitted to ICU required

ventilator support .Majority of them also required special
interventions like multiple transfusions of blood products
Figure 1: Emergency and booked case. (55.5%), dialysis (6.6%), central venous pressure lines
(35.5%) and vasoactive infusions (15.5) (Table 2).

40 Table 2: Interventions done.

30 No. of
Interventions %
patients
20 No. of Blood & blood products 25 55.5
patients Central venous pressure line 16 35.5
10
Ventilator 11 24.4
0 Vasoactive infusions 07 15.5
Antepartum Postpartum Dialysis 03 6.6

Out of the 45 obstetric admissions in ICU, 9 patients died

Figure 2: Gestational age. (20%) and remaining were discharged. Most of the
maternal deaths were due to multiorgan dysfunction and
Mean maternal age was 24.36 ± 8 years; the youngest Disseminated Intravascular Coagulation (DIC).Sepsis and
being 19 and eldest 41 years of age (Figure 3). 12 patients medical disorders like tuberculosis meningitis, cardiac
(26%) were primigravidas. Advancing age affects disease were the other causes (Table 3).
outcome of critically ill patients and youth confers an
advantage for obstetric patients. Table 3: Cause of death.

No. of
Causes %
patients
Multiorgan failure with ARDS 03 6.6
DIC 03 6.6
Tubercular meningitis 01 2.2
Myocarditis 01 2.2
Sepsis 01 2.2

DISCUSSION

The critical care aspects in obstetrics are varied and

Figure 3: Age wise distribution. demand that critical care practitioners have a thorough

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 · Issue 2 Page 371
 Bendre KR et al. Int J Reprod Contracept Obstet Gynecol. 2015 Apr;4(2):370-372

knowledge of fetal and maternal changes in physiology as this facility is necessary. Establishment of First Referral
pregnancy progresses. Pregnancy can affect every organ Unit (FRU) for management of emergency obstetric
system and organ specific conditions.4 In this study the patients should be a priority. Early referral to a tertiary
obstetric patient ICU admission rate was 0.4%. This rate care centre coupled with invasive hemodynamic
is higher as compared to a multicentric study done by monitoring and ventilator support improves outcome of
Hazelgrove et al.5 where it was 0.17% which included 14 such patients. Maternal- fetal medicine specialist is a step
ICU’s in South England over a period of 3 years; but towards the betterment of such patients. A short period of
other studies have reported similar rates between 0.3 to training of residents and staff in ICU will help managing
0.7%.6,7 these patients till they are transferred to tertiary centres.

The most common reason for admission in ICU in our Funding: No funding sources
study was obstetric hemorrhage (42.2%); the second Conflict of interest: None declared
reason was hypertensive disorders that accounted for Ethical approval: The study was approved by the hospital
33.3% of all admissions. These are similar to study done ethics committee
by Mahulte et al. and Daniela et al.6,7 In our study ICU
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DOI: 10.5455/2320-1770.ijrcog20150416
Cite this article as: Bendre KR, Tuteja TV, Niyogi
Availability of good obstetric care is the cornerstone to GM. Critically ill obstetric patients. Int J Reprod
decrease maternal mortality. Educating women to avail Contracept Obstet Gynecol 2015;4:370-2.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 · Issue 2 Page 372