Epidemiology and Clinical Profile of Critically Ill Obstetric Patients Requiring ICU Admission – An Observational Tertiary Care Center Study in North India

INTRODUCTION: Many physiological and anatomical changes during pregnancy led a difficult challenge to manage critically ill obstetric patients and often requires a multidisciplinary approach. Many of these patients specially from rural background referred late in moribund conditions. To manage such critically ill obstetric patients need to establish obstetric high dependency & intensive care units is of utmost importance. Admissions to intensive care unit (ICU) is one of the ways to approach epidemiology and clinical profile of critically ill obstetric patients. OBJECTIVES: To evaluate incidence, determinants responsible for ICU admissions and to analyze clinical characteristics and intervention required for obstetric patients. MATERIALS AND METHODS: A prospective observational study carried out in Obstetrics ICU over a period of one year. Critically ill obstetric patients defined as per APACHE II score were enrolled. Gynecological patients and non-critical obstetric patients were excluded. Clinical data including diagnosis at the time of admission, indication for ICU admission, duration of ICU stay, need for dialysis, mechanical ventilation, intervention and maternal outcome was analyzed. RESULTS: Out of the total 12,500 obstetrics patients, 807 were critically ill, thus incidence of critically ill women requiring ICU admission was 6.4%. Most common aetiology was hypertensive disorders of pregnancy (45.2%), acute kidney injury (33.1%), Liver disorders 27.7%, Obstetric hemorrhage 21.5%, heart diseases 13.4%. 23.5% had Sepsis, 41.6% required anti-hypertensives, 37.6% required anticonvulsant and 6.9% required diuretics, vasopressor drugs required in 28.6% and dialysis in 7.4%. 7.8% patients expired. Maximum number of deaths (74.3%) were observed within 2 days of ICU admission. Requirement of ventilator support was limited to 24 hours in maximum women (59.6%). At cut off of >10.50, SOFA score was 62.9% Sensitive and 95.9% Specific and APACHE-II score at cut off >20.50, 74.3% sensitive and 90.3% Specific. Duration of ICU stay and mortality was significantly associated with high APACHE-II score. CONCLUSIONS: Role of obstetric ICU to manage critically obstetric patients and provision of mechanical ventilation play very important role in the reduction of maternal morbidity and mortality.