Predictors of mortality in critically ill obstetric patients in a tertiary care intensive care unit: A prospective 18 months study

• Published in: Journal of obstetric anaesthesia and critical care Vol. 8; no. 2; pp. 73 - 78
• Main Authors: Sodhi, Kanwalpreet, Bansal, Venus, Shrivastava, Anupam, Kumar, Manender, Bansal, Namita
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01.07.2018; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Critically ill; Developing countries; intensive care unit treatment; Maternal mortality; mortality; obstetric patients; India; mortality; intensive care unit treatment; obstetric patients; Critically ill
• ISSN: 2249-4472
• DOI: 10.4103/joacc.JOACC_57_17

Introduction: Intensive care units (ICUs) receive obstetric patients with medical and surgical complications as well as obstetrical emergencies. These patients needing intensive care present an exclusive challenge both for the obstetrician as well as the intensivist. In developing countries such as India, due to scarcity of ICU resources, maternal morbidity and mortality of such patients is high. Objectives: The aim of our study was to examine the pattern of admission, prevalence, causes, and the outcomes of critically ill obstetric patients admitted to an Indian ICU and the factors affecting mortality. Materials and Methods: A prospective study of all obstetric patients (pregnant and within 6 weeks postpartum) admitted in a 48-bedded ICU of a tertiary care hospital over a period of 18 months from January 2015 to June 2016 was done. The data collected included demographics, obstetric and medical history, illness severity scores, organ failures, treatment given, the ICU stay, hospital stay, and outcomes. Results: A total of 48 obstetric patients were admitted in the ICU during the study period. Mean age was 29.27 ± 5.910 years, mean APACHE-II was 12.77 ± 7.553, and SOFA score was 6.36 ± 4.235. Postpartum hemorrhage was the commonest cause for ICU admission (23%). Of the study patients, 40% had sepsis, 33% had multiorgan failure, 48% required ventilator support, and 25% had need for vasopressors. Mortality of study patients was 8.3%. Average ICU stay was 6.6 days. APACHE-II, SOFA scores, ICU stay and hospital stay, and multiorgan failure are significant predictors of mortality in obstetric critically ill patients. Conclusion: APACHE-II, SOFA scores, and ICU stay are strong predictors of maternal mortality in ICU. APACHE-II and SOFA scores overpredict mortality in obstetric patients. Early assessment and intervention of critically ill obstetrical patients with a team approach involving obstetricians and intensivists is ideal. All obstetric residents should have a mandatory short ICU training.