ICU Admission and Outcome in Obstetrics

Abstract Background: Obstetric patients represent a unique population in the intensive care unit (ICU) due to the physiological changes of pregnancy and the need to care for both the mother and fetus. ICU admission during pregnancy and the puerperium is often associated with life-threatening complications and adverse maternal and perinatal outcomes Introduction: Obstetric patients represent a distinct group in critical care due to the dual concern of maternal and fetal well-being. ICU admission in pregnancy and the puerperium often indicates severe maternal morbidity and mortality and is associated with high maternal risk. This study aims to analyze the incidence, indications, clinical characteristics, interventions, and outcomes of obstetric ICU admissions in a tertiary care center. Methods: This was a descriptive observational study conducted at Mahadevappa Rampure Medical College, Kalaburagi. All obstetric patients—antenatal, intrapartum or within six weeks postpartum—admitted to the ICU over the study period were included. Data collected included age, parity, gestational age, timing of ICU admission, primary diagnosis, types of ICU interventions, and outcomes. Results: A total of 60 obstetric patients required ICU admission. The majority (55%) were below 25 years of age, and 56% were multigravidae. The highest proportion of ICU admissions occurred between 34–37 weeks and <34 weeks, comprising 26.6% of patients, indicating a high burden of preterm complications. 18.3% were admitted at <28 weeks. Term pregnancies (>37 weeks) accounted for 15%, and postpartum admissions made up 13.3%.The most common indication for ICU admission was pre-eclampsia (28.3%), followed by abruptio placentae (15%), cardiac disorders (13.3%), anemia (13.3%), and eclampsia (11.6%). Other causes included PPH, HELLP syndrome, sepsis, DIC, acute fatty liver and transfusion reactions.The most frequently required interventions were blood transfusion (60%), oxygen therapy (50%), mechanical ventilation (23.3%), and inotropic support (20%).Most patients (62%) had an ICU stay of 1–3 days, while 24% stayed 4–7 days, and 14% stayed longer than 7 days.Outcomes were favorable in most cases: 88.3% recovered, 3.3% were referred, and 8.3% died. Discussion: This study highlights that hypertensive disorders and obstetric hemorrhage are the leading causes of ICU admissions. The need for mechanical ventilation, blood transfusions, and inotropic support underscores the severity of these cases. Despite intensive care, maternal mortality occurred in a small proportion. Delayed referral, lack of antenatal care, and resource constraints were important contributing factors. These findings reflect broader national and international patterns and emphasize the need for improved obstetric emergency care systems. Conclusion: ICU admission in obstetric patients is a marker of severe morbidity. Hypertensive disorders, hemorrhage, and sepsis remain the primary causes. Early identification, timely referral, a multidisciplinary approach, and well-equipped ICUs are key to improving maternal and neonatal outcomes. Strengthening antenatal care, risk stratification, and critical care training in obstetrics is essential to reduce preventable morbidity and mortality.