Obstetric Intensive Care Unit Admissions Research Articles

Long-Term Quality of Life After Obstetric Intensive Care Unit Admission: A Cross-Sectional Cohort Study

(BJOG. 2024;130(7):813–822) Women admitted to the intensive care unit (ICU) during pregnancy or postpartum have altered their physical and psychological quality of life (QoL). Maternal and perinatal mortality and morbidity are distressing issues impacting many facilities. The long-term impact of peripartum ICU admission is unknown. Two prior studies on QoL after obstetric ICU admissions have found it important to record the physical and emotional impact on the patient and their family.

Long-term quality of life after obstetric intensive care unit admission: A cross-sectional cohort study.

To assess the long-term quality of life (QoL) after obstetric Intensive Care Unit (ICU) admission. Cross-sectional survey study. Tertiary care centre. Women admitted to the level 3 ICU during pregnancy or ≤6 weeks postpartum, between 2000 and 2015. Quality of life measures were compared with the population reference values. Associations with baseline ICU parameters were assessed with multivariable linear regression. Patient-reported outcome and experience measures (PROMs/PREMs) were described. Quality of life according to the Linear Analogous Scale (LAS), the Satisfaction with Life Scale (SWLS) and the SF-36 questionnaire; PROMs/PREMs using the Pregnancy and Childbirth outcome set of the International Consortium for Health Outcomes Measurement. Of all 265 obstetric ICU admissions, 230 were eligible and 94 (41%) were included (median follow-up time 14 years). The LAS (75.7 versus 78.7, p=0.077) and SWLS (25.2 versus 26, p=0.176) sum scores were not different from the population reference values. The SF-36 subdomains bodily pain (55.3 versus 73.9), general health (58.2 versus 73.9) and vitality (56.9 versus 69.1) were lower than the reference values (all p < 0.001). PROMs/PREMs were low in 46.2% for pain, 15.1% for depression, 11.8% for satisfaction with care and 52.7% for healthcare responsiveness. An indirect obstetric ICU admission diagnosis was independently associated with a reduced physical health score (B -1.7, 95% confidence interval [CI] -3.4 to -0.1) and severe neonatal morbidity with a reduced mental health score (B -6.6, 95% CI -11.3 to -1.8). Obstetric ICU admission is associated with reductions in long-term physical health QoL and in some patients with mental health QoL. We suggest multidisciplinary rehabilitation and long-term psychosocial support.

A Five-Year Review of Obstetric Admission to Intensive Care Unit at Hatyai Hospital

Objective: To ascertain the prevalence, characteristics, and outcomes of obstetric patients admitted to the intensive care unit (ICU) at Hatyai Hospital. Materials and Methods: A retrospective medical chart review of all pregnant women and postpartum patients at less than 42 days admitted to the ICU between October 2014 and September 2019 was done. Results: There were 32,613 deliveries in Hatyai Hospital during the five-year study period, with 137 obstetric patients admitted to the ICU. The prevalence of obstetric ICU admissions was 0.42%. The main reasons leading to ICU admission were postpartum hemorrhage at 56.93%, followed by pregnancy-induced hypertension at 14.60%. Mechanical ventilation, at 86.13%, was the most common intervention in ICU admissions, with a five-year mortality rate of 3.64%. Conclusion: The prevalence of obstetric ICU admissions was 0.42%. Postpartum hemorrhage and pregnancy-related hypertension with complications were the two common obstetric indications for ICU admissions. The maternal mortality rate was low. A multidisciplinary team approach is mandatory in the care of obstetrical emergencies. Keywords: Maternal mortality; Pregnancy-induced hypertension; Postpartum hemorrhage; Intensive care unit

Assessment of the Clinical Profiles of the Obstetric Patients Admitted to ICU in a Tertiary Care Hospital, Madhya Pradesh, India: A Longitudinal Study

Introduction: Management of critically ill obstetric population admitted to Intensive Care Unit (ICU) remains a significant hurdle in developing countries. Aim: To examine demographic characteristics, diagnoses, clinical outcomes, and performance of modified Sequential Organ Failure Assessment (SOFA) score between survivors and non survivors in all obstetric admissions to the ICU. Materials and Methods: This was a longitudinal study conducted in a 12-bedded obstetric ICU at 850 bedded Netaji Subhash Chandra Bose Medical College, Madhya Pradesh, India from March 2016 to August 2017. Clinical profile and outcomes of ICU patients were analysed for total 367 obstetric ICU admission. To determine mortality outcomes of the study population, a modified SOFA score was used to take into account physiological changes in pregnancy. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 15.0 (Inc., Chicago, Illinois, USA). Receiver Operating Characteristics (ROC) curve analyses of SOFA score as a predictor of mortality, and optimum cutoff point value was determined. Results: The mean age of the study population was 24.7±4.0 years. Eclampsia (35.7%) and preeclampsia (13.62%) were the leading indications of admission. The survival of patients was associated significantly with low SOFA scores with mean SOFA score of 6.48±2.804 among survivors and 10.42±3.579 among non survivors (p-value=0.001). Conclusion: Eclampsia and preeclampsia were the leading cause of ICU admission, that can be preventable. Higher SOFA score was related to higher mortality in the obstetric patients requiring ICU.

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

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. 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. 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. 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. 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.

Pregnancy related and postpartum admissions to intensive care unit in the obstetric tertiary care center - an 8-year retrospective study.

The purpose of the study was to analyze the incidence of maternal morbidity and mortality of pregnant and postpartum women admitted to the intensive care unit (ICU). Retrospective analysis of all pregnant and postpartum patients admitted to ICU of the obstetric tertiary care center between January 1, 2007 and December 31, 2014. A total of 266 patients with pregnancy and postpartum related morbidity were admitted to ICU (12.56 per 1000 deliveries). It accounted for 21.08% of all adult admissions of the unit. Mean age was 30.2 ± 5.6 years, mean gestational age was 30.8 ± 7.6 weeks. Two hundred forty patients (90.23%) were primiparous, 17 (6.4%) were twin pregnancy. Main reasons of admission included hypertensive disorders of pregnancy n = 99 (37.22%; 4.68 per 1000 deliveries), hemorrhage n = 46 (17.29%; 2.17 per 1000 deliveries) and sepsis/infection n = 46 (17.29%; 2.17 per 1000 deliveries). Median length of stay was five days (IQR 4-7). Artificial ventilation was required in 91 patients (34.21%), 147 (55.26%) required vasoactive drugs, 33 (12.41%) had metabolic disturbances, 21 (7.89%) required total parenteral nutrition and 4 (1.50%) renal replacement therapy. We report four maternal deaths (1.5%; 0.19 per 1000 deliveries). There are three main reasons of obstetric ICU admissions: hypertensive disorders of pregnancy, obstetric hemorrhage and sepsis/infection. The majority of obstetric patients admitted to ICU did not require multi-organ supportive therapy. Availability of intermediate care facility could reduce unnecessary admission to ICU.

A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study

Aims and objectivesTo study clinical profile of obstetric patients admitted to intensive care unit (ICU) and to analyze the relation of demographic factors such as age, parity, literacy level, socioeconomic status, acute physiology and chronic health evaluation II (APACHE II) score, and level of delay with fetomaternal outcome.DesignIt is a prospective cross-sectional observational study.Materials and methodsAfter admission to ICU a detailed history, analysis of basic demographic variables along with level of delay was done. APACHE II score was calculated. These parameters were correlated with fetomaternal outcome. The Chi-squared test was used to compare categorical variables. The one-way analysis of variance was used to compare the continuous variables among the strata with Tukey's post hoc test.ResultsIncidence of obstetric ICU admission was 0.77%. Mean age was 26.03 years. Most common indication of ICU admission was obstetrical hemorrhage (37.1%) followed by hypertensive disorders of pregnancy (25.8%). Type I delay was the most common followed by type II delay. Mean APACHE II score was 14.77 ± 6.85. Observed mortality rate (30.6%) was found to be higher than predicted mortality rate (25%). APACHE II score was significantly high in the presence of level 1 (p = 0.003) and level 2 delays (p = 0.0001). Also, it was significantly increased with the duration of delays.ConclusionUnbooked and referred cases had high incidence of ICU admission. The presence of delay was associated with poor outcome.How to cite this articleMiglani U, Pathak AP, Laul P, Sarangi S, Gandhi S, Miglani S, et al. A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study. Indian J Crit Care Med 2020;24(11):1071–1076.

Maternal and Neonatal Characteristics in Obstetric Intensive Care Unit Admissions

(Int J Obstet Anesth. 2020;41:65–70) The World Health Organization defines severe acute maternal morbidity as “a woman who nearly died, but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” Intensive care unit (ICU) admission resulting from maternal morbidity is most commonly associated with hemorrhage-related cardiovascular instability and severe preeclampsia. This retrospective register-based study from January 2007 to December 2011 held 3 objectives: (1) to evaluate the course of pregnancy and delivery for obstetric patients admitted to ICU, (2) discern the health status of infants born to those women, and (3) comparison of the results with reference data on Finnish parturients and infants.

Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception

(Anesth Analg. 2020;130:436–444) As births using assisted reproductive technology increase, the maternal and neonatal safety of these pregnancies continues to be of concern. There are established associations between assisted reproductive technology pregnancies and a number of adverse outcomes, including gestational diabetes, hypertensive disorders of pregnancy, obstetric hemorrhage, abnormal placentation, and cesarean delivery. There is a lack of studies examining the risk of intensive care unit (ICU) admission in women using assisted reproductive technology. This study compared parturients who conceived via in vitro fertilization (IVF) and those who did not in terms of etiology and course of ICU admission, particularly focusing on postpartum hemorrhage.

Characteristics and preventability of obstetric intensive care unit admissions in Far North Queensland.

The rarity of maternal deaths in developed countries has increased interest in auditing cases of severe maternal morbidity or maternal 'near miss'. The assessment and preventability of cases of maternal 'near misses' are important in improving the provision of maternity care. To describe the epidemiology and determine aspects of preventability in care among women admitted to an obstetric intensive care unit (ICU) in Far North Queensland. A retrospective observational study of pregnant and postpartum patients admitted to the Cairns Hospital ICU between 1 January 2013 and 31 December 2017 was undertaken. Cases of severe maternal morbidity were identified using the World Health Organization (WHO) 'near miss' criteria and reviewed to determine reasons for admission to ICU and ascertain aspects of preventability in the care provided. Sixty-nine out of 12081 (0.6%) women admitted for obstetric care were transferred to the ICU with 31 cases fulfilling WHO 'near miss' criteria. The most common direct obstetric-related diagnosis for ICU admission was hypertensive disease of pregnancy and obstetric haemorrhage. Indirect obstetric causes contributed to approximately 40% of ICU admissions. Among the 31 cases of WHO 'near miss', ten cases were deemed preventable with the most common reason for preventability related to lack of recognition of high-risk clinical status. Maternal 'near miss' and rates of obstetric admission to the ICU at Cairns Hospital are reassuringly low. Nevertheless, one-third of women with 'near miss' required improvements in the provision of care, emphasising the need for continued audit and improvement of clinical practice.

Obstetric admissions to intensive care units in Australia and New Zealand: a registry-based cohort study.

Describe the epidemiology of obstetric patients admitted to an Intensive Care Unit (ICU). Registry-based cohort study. One hundred and eighty-three ICUs in Australia and New Zealand. Women aged 15-49years, admitted to ICU between 2008 and 2017, classified as pregnant, postpartum or with an obstetric-related diagnosis. Data were extracted from the Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and national agencies. Incidence of ICU admission, cohort characteristics, maternal outcomes and changes over time. The cohort comprised 16063 patients. The annual number of obstetric ICU admissions increased, whereas their proportion of total ICU admissions (1.3%) did not change (odds ratio 1.02, 95% CI 0.99-1.04, P=0.14). There were 10518 (65%) with an obstetric-related ICU diagnosis, and 5545 (35%) with a non-obstetric ICU diagnosis. Mean (SD) age was 31 (6.4) years, 1463 (9.1%) were Indigenous, 2305 (14%) were transferred from another hospital, and 3008 (19%) received mechanical ventilation. Median [IQR] length of stay in hospital was 5.2 [3.1-7.9] days, which included 1.1 [0.7-1.8] days in ICU. There were 108 (0.7%) maternal deaths, most (n=97, 90%) having a non-obstetric diagnosis. There was no change in risk-adjusted length of stay or mortality over time. Obstetric patients account for a stable proportion of ICU admissions in Australia and New Zealand. These patients typically have a short length of ICU stay and low hospital mortality. Obstetric patients in Australia/New Zealand ICUs have a short length of ICU stay and low mortality.

Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception.

The use of in vitro fertilization is increasing. The incidence of adverse outcomes is greater for women who undergo in vitro fertilization, potentially leading to intensive care unit admission. This study aimed to assess the etiology and course of intensive care unit admission in women who underwent in vitro fertilization compared to those who did not, with specific focus on intensive care unit admission due to postpartum hemorrhage. In this retrospective study, medical records of patients admitted to the intensive care unit during pregnancy or the peripartum period at 2 medical centers (2005-2016 at Mount Sinai Hospital, New York, NY, and 2005-2013 at Shaare Zedek Medical Center, Jerusalem, Israel) were analyzed. Demographic, past medical and obstetric history, and details regarding delivery and intensive care unit stay were collected, as was information regarding mode of conception (in vitro fertilization versus non-in vitro fertilization) for the current pregnancy. The primary outcome measure was difference in etiology of intensive care unit admission between in vitro fertilization and non-in vitro fertilization groups. Secondary outcome measures included differences in prepregnancy characteristics, incidence, severity, and management of postpartum hemorrhage, as well as incidence of other clinical major morbidity events and delivery-related complications. Multivariable logistic regression was performed to study the relationship between in vitro fertilization and the odds of having been admitted to the intensive care unit due to hemorrhage. During the study period, there were nearly 192,000 deliveries, with 428 pregnant and peripartum women admitted to the intensive care unit. Of the 409 cases analyzed, 60 had conceived following in vitro fertilization and 349 had conceived without in vitro fertilization. The non-in vitro fertilization group was more likely to have multiple medical comorbidities, and the in vitro fertilization group was more likely to have multiple gestations. The groups also differed in etiology of intensive care unit admission; more women in the in vitro fertilization group were admitted due to a pregnancy-related complication. Intensive care unit admission for postpartum hemorrhage was more frequent in the in vitro fertilization group (60.0% vs 43.1%, P = .014), with a 2-fold increase in the incidence of hemorrhagic shock. Logistic regression analysis revealed a 2-fold increase in the odds that intensive care unit admission was due to hemorrhage in women undergoing in vitro fertilization, a finding that was not statistically significant when multiple gestation was added to the model. Among patients admitted to the intensive care unit, patients with different modes of conception had dissimilar etiologies for intensive care unit admission with intensive care unit admission due to hemorrhage greater in those with in vitro fertilization. Higher rates of multiple gestation pregnancies may explain this difference. Differences in pregnancies conceived via in vitro fertilization versus without in vitro fertilization may affect the obstetric intensive care unit case mix.

Maternal and neonatal characteristics in obstetric intensive care unit admissions

BackgroundThe objective of this study was to evaluate the course of pregnancy and delivery of obstetric patients admitted for intensive care, and determine the health status of their infants. MethodsThis was a retrospective register-based study. Four university hospitals in Finland participated. Obstetric patients admitted to the intensive care unit in any trimester of pregnancy, during delivery or up to 42 days post partum were identified from clinical information systems over a five-year study period. Parturient and infant data were collected from the Medical Birth Register. ResultsDuring the study period (2007–2011), 283 obstetric patients were identified from the clinical information system. The most common reason for admission was hypertensive complications (58%), followed by obstetric haemorrhage (25.1%). Advanced maternal age, nulliparity and multiple pregnancies were associated with obstetric intensive care unit admissions. Of patients admitted to intensive care, 68.9% delivered by unscheduled caesarean section. Nearly 60% of neonates were born preterm, 56.1% needed treatment in a neonatal intensive care unit or an observation unit and 4.6% died within one week. ConclusionAdvanced maternal age, nulliparity and multiple pregnancy were more common among intensive care unit-admitted women than in the general obstetric population. The main causes for admission were hypertensive complications and obstetric haemorrhage. Compared with the general obstetric population, neonates of intensive care unit-admitted mothers were eight times more likely to require treatment on a neonatal ward and their risk of neonatal death was also eight times greater.

Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center.

ObjectiveReviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women.MethodsRetrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994–2004; period 2: 2005–2015) and place of delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used to evaluate the usefulness of APACHE II score to predict maternal mortality.ResultsDuring 22-year period, 176 women required ICU admission, showing the incidence of 2.2 per 1,000 deliveries. The most common reason for ICU admission was postpartum hemorrhage (56.3%), followed by hypertensive disorders (19.3%), sepsis (3.4%), and pulmonary and amniotic fluid embolism (2.3%). Period 2 showed older maternal age (32.7±4.8 vs. 30.8±4.4 years, P=0.006, higher embolization rate (26.4% vs.1.2%, P<0.001), and lower hysterectomy rate (30.8% vs. 49.4%, P=0.012). Cases from local hospitals showed significantly higher proportion of postpartum hemorrhage (84.5% vs. 42.2%, P<0.001). Overall maternal death occurred in 5.1% (9/176) including 6 direct maternal deaths. The APACHE II score showed area under the ROC curve of 0.813 (confidence interval [CI], 0.607–1.000) for prediction of maternal mortality.ConclusionThe incidence of obstetric ICU admission was 2.2 per 1,000 deliveries and the most common reason was postpartum hemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.

Outcomes of Antepartum and Postpartum Obstetric Admissions to the Intensive Care Unit of A Tertiary University Hospital: An 8-Year Review.

Although their rates are decreasing, pregnancy-related mortality and morbidity are problems worldwide. In this study, we aimed to review the characteristics, diagnoses, required interventions and outcomes of obstetric patients admitted between 2006 and 2014 to the Intensive Care Unit (ICU) of a tertiary university hospital to provide an indicator for improving the management of critically ill obstetric patients. A retrospective study of hospital records of obstetric admissions to the ICU was conducted. The pregnancy-related ICU admission rate was 0.21% among all deliveries during the study period. Nine antepartum (mean gestational age: 23 weeks) and 48 postpartum (mean gestational age: 34 weeks) obstetric ICU admissions were included. Most obstetric patients admitted antepartum were primiparous (88.8%), whereas those admitted postpartum were multiparous (64.6%). The mean ICU stay was 7 days among the patients admitted antepartum and 6 days among those admitted postpartum. Common medical reasons for ICU admission were respiratory failure and HELLP syndrome in both groups; DIC and eclampsia were also medical reasons causing ICU admission among the postpartum patients. Mechanical ventilation and blood derivative transfusion were the most common interventions required during the ICU stay of the obstetric patients. Maternal death was unique to the patients admitted postpartum (6 patients, 12.5%). We reviewed obstetric admissions to our institution over an 8-year period. We believe that a nationwide study in Turkey that provides an indicator of the frequency, reasons of ICU admission and outcome of obstetric patients is required to improve the quality of intensive care.

Medical emergency team may reduce obstetric intensive care unit admissions.

Some recent studies have reported that early intervention by a medical emergency team (MET) for clinical deterioration before intensive care unit (ICU) admission was associated with a survival benefit in critically ill cancer patients. We hypothesized that early MET intervention for an obstetric crisis in the general wards would be related to favorable outcomes in critically ill obstetric patients. Data of obstetric patients who were managed by a MET were collected retrospectively from 1 March 2008 to 30 April 2015. A total of 69 obstetric patients were enrolled. Among them, 48 (69.6%) were treated successfully in the general wards and 21 (30.4%) were transferred to the ICU. Major causes of MET activation were pulmonary edema (n = 23, 33.3%), hypovolemic shock (n = 19, 27.5%), and septic shock (n = 8, 11.6%). Compared with the patients treated in the general ward, the patients transferred to the ICU had significantly higher severity of illness score. Sequential Organ Failure Assessment score was the most useful for prediction of ICU admission of obstetric patients (AUC, 0.810, P < 0.001), and the ideal cut-off was 4 (sensitivity, 81%; specificity, 60%). During the study period, in-hospital mortality of the obstetric patients was 2.9% (2/69). After MET activation many obstetric patients could be successfully treated in the general wards without mortality. Therefore, MET may reduce ICU admissions in critically ill obstetric patients.

Obstetric Intensive Care Unit Admission: A Six Year Cohort Study

One in a thousand pregnancies will be complicated by serious maternal morbidity warranting intensive care unit (ICU) admission before, during or after delivery. Between 2007 and 2009 maternal mortality in France was one in ten thousand, about half of them are considered preventable.

Obstetric intensive care admissions at a tertiary hospital in Limpopo Province, South Africa

Objective. To determine the characteristics of obstetric patients admitted to the intensive care unit (ICU) at a tertiary hospital in the Limpopo Province, South Africa. Methods. Hospital files of all obstetric patients admitted to the Pietersburg provincial referral hospital ICU from 1 January 2008 to 31 December 2012 were retrospectively reviewed. Age, parity, admission diagnosis, length of stay, information on the referring hospitals, and maternal outcomes were analysed. Results. There were 138 obstetric ICU admissions during the study period (6.7% of all ICU admissions and 0.95% of all deliveries). The most common reasons for obstetric ICU admissions were pre-eclampsia or eclampsia (52.9%, n =73/138) and obstetric haemorrhage (18.1%, n =25/138). The mean age of the patients was 28 years, and mean duration of ICU stay was 8 days (range 0 - 163 days). Forty-eight maternal deaths occurred (34.8%), and of these, 27 were referrals from other hospitals (district and regional hospitals). Pre-eclampsia or eclampsia accounted for 25 (52%) of all deaths. Conclusion. Obstetric patients formed a small proportion of ICU admissions, but mortality among these patients was high. It is re­commended that obstetric registrars rotate through a multidisciplinary ICU, and the need for a critical care specialist should be considered.

Clinical Audit of Quality of Intrapartum Care in a State University Teaching Hospital, Enugu, Southeast, Nigeria

Objectives: To assess the quality of intrapartum care in Enugu State University Teaching Hospital, Enugu. Methods: This retrospective clinical audit on intrapartum care quality indicators in the birth, newborn, intensive care unit and theatre registers was undertaken from January1, 2010 to December 31, 2014. Data was analyzed using excel 2007 software and has been presented using percentages. Results: A total of 5211 women delivered 5385 babies (including174 twins). Majority of the women were of ages between 20-35 years (3995/5211, 76.7%), parity 2-4 (3001/5211, 56.7%) and booked (3731/5211, 71.6%). Preterm delivery ( 1000 mls) in (45/5211, 0.9%) women. Eclampsia (40/5211, 0.8%) and obstetric intensive care unit admissions (30/5211, 0.6%) were documented. Fifteen maternal deaths (15/5211, 0.3%) occurred giving a maternal mortality ratio of 292/100000 live births. The commonest cause of maternal death was postpartum-eclampsia. Apgar score <7 at 5 minute occurred in (531/5385, 9.9%) while 319 babies (319/5385, 9.0%) were admitted to newborn intensive care unit. The stillbirth rate was (256/5385, 4.8%). The neonatal death and perinatal mortality rates for 2012 to 2014 were (25/3314, 0.8%) and (194/3314, 5.9%) respectively. Conclusion: Regular audits of intrapartum care quality indicators are essential for early detections of areas of poor-quality that demand immediate improvements to avoid further feto-maternal harms.

Obstetric admissions to the intensive care unit of a tertiary hospital in northern India

Objective : To determine the causes of the obstetric admissions to the intensive care unit (ICU) and the impact of antenatal care on ICU admission. Methods : Obstetric ICU admissions over the two years from May 2009 to May 2011 at Maulana Azad Medical College and associated Lok Nayak Hospitals, New Delhi, were analyzed retrospectively. Results : The 136 obstetric admissions to the ICU represented 0.8% of all the deliveries in the hospital during that period. The majority (76%) of women were transferred to the ICU postpartum. Obstetric haemorrhage(56.1%), hypertension(19.8%), and endotoxic shock(12.5%) were the major obstetric cause of the ICU admission. Together with the cardiac disease, DIC, infections, they formed 91.4% of all the admissions. Anaesthetic complications were responsible for 2.9% of them. Of all the admissions, 12% were completely unbooked and uninvestigated during the whole antenatal period, 85% were registered/ booked at other hospitals and 3% were booked in our hospital. The maternal mortality was 19.1% of all the ICU admissions in this study, and the mortality rate in unbooked patients was 58%. Conclusion : The most common precipitants of ICU admission were obstetric haemorrhage and uncontrolled hypertension, both of which can be managed well if the patient has complete antenatal visits and investigations. This reflects the importance of ante-natal care, so that the high risk pregnant female can be identified in advance, referred at appropriate time to the higher centre and managed meticulously.