Study of Obstetric Patients Requiring ICU Admission and Fetomaternal Outcome

Background: Pregnancy and postpartum tend to bring several physiological changes in the body of females, which can sometimes cause life-threatening complications. In developing countries, because of the high burden of hypertensive disorders, hemorrhage, and sepsis, obstetric patients requiring intensive care admission are a major public health concern. Early recognition of complications and ICU management plays a critical role in improving fetomaternal outcomes. The current study aimed to study the clinical profile of obstetric patients requiring ICU admission and assess maternal morbidity and mortality, including the associated perinatal outcomes. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care hospital from November 2022 to September 2024. A total of 93 obstetric patients, including antenatal and postnatal women within 42 days of delivery, who required ICU admission, were enrolled. Data regarding sociodemographic factors, antenatal care, parity, mode of delivery, cause of ICU admission, interventions, and maternal and perinatal outcomes were collected and analyzed. Results: The overall ICU admission rate in this study was 1.94% most of the cases (41.9%) were aged between 26 and 30 years, and the mean age of the cohort was 27.34 ± 4.8 years. Unbooked cases were common, 60.2% and multigravidas were in 67.7% and primigravidas were in 32.3%. The most frequent cause for admission was due to obstetric causes in 76.3%, followed by blood transfusion in 48.4% and blood product transfusion in 34.4%. The maternal survival rate was 82.8% with mortality in 17.2% of cases. Maternal mortality was significantly associated with higher SOFA scores. The leading causes of maternal mortality were ARDS with respiratory failure (25%) and HELLP with MODS (25%). Perinatal mortality was 16.1%, and 19.4% of neonates required NICU admission. Conclusion: Hypertensive disorders and obstetric haemorrhage were the leading causes of ICU admissions. Maternal mortality was significantly associated with ventilator requirement and higher SOFA scores. Poor antenatal care and delayed referral contributed to adverse outcomes. Strengthening antenatal services, timely referral, and multidisciplinary ICU care can improve fetomaternal survival.