Critical care utilisation, and outcomes of critically ill obstetric patients in India: a multicentre ICU registry study (2019–2024)

Background We aimed to characterise the case mix, severity scores, organ support interventions and outcomes of obstetric patients admitted to 40 ICUs in India over a 5 year period. Methods We analysed prospectively collected data from the Indian Registry of IntenSive care (IRIS) including female patients aged 15–49 years admitted between January 2019 and November 2024. Obstetric patients were compared with non-obstetric female ICU patients. The obstetric cohort was further stratified by surgical and hospital status. Findings Obstetric patients constituted 5.8% (577/10006) of women of reproductive age admitted to 40 ICUs, of which 9 were public. These women were younger (median 29 versus 37 years), more often admitted after surgery, with similar acuity of illness, organ support use and ICU length of stay–but lower ICU mortality (3.3% versus 7.9%, Absolute standardised Difference ASD=0.2) than the non-obstetric cohort. Within the obstetric patients, non-operative patients required less organ support but longer ICU stays. Patients admitted to public ICUs had higher illness severity at admission (median APACHE II score 12 versus 8, p=0.001), higher crude ICU mortality (6.4% versus 2.1%, p=0.02), albeit with comparable standardised mortality rates. Interpretation Critically ill obstetric patients present with distinct clinical trajectories and outcomes. APACHE II score overestimated mortality in obstetric patients. Public ICUs face higher illness severity and worse crude mortality, but comparable risk-adjusted outcomes to private ICUs. Registries provide a scalable platform to support evidence-based maternal critical care planning in India. Funding The IRIS registry is part-funded by the Wellcome Trust.