Abstract
Background: Maternal mortality is an important public health problem especially in backward states of India like Madhya Pradesh. Obstetric cases may also have serious medical causes of morbidity and mortality which maybe preventable. The knowledge of their spectrum may help in instituting steps for their prevention.
Aims: To study the spectrum of critically ill obstetric cases admitted in Medical ICU in Gwalior.
Methodology: This is a prospective observational study conducted among obstetric patients admitted to Medical ICU between January 2017 to September 2018 in a medical college in Gwalior.
Results: A total of 100 consecutive cases were studied and the mean age of the subjects was 24 years. 62 % of the patients were ANC and 38% were PNC. Majority of the ANC patients were multigravida (58.03%).Most common diagnosis in the present study was Severe Anaemia (31%). Overall mortality was 13% with overwhelming majority having a qSOFA score ≥2(P < 0.001).Most common cause of mortality in present study was Hepatic encephalopathy (53.84%) followed by Severe anaemia with sepsis (30.77%). Most common interventions required were packed RBC transfusions (67%), followed by mechanical ventilation (12%) and inotropic support (12%).
Conclusion: The qSOFA score was found to be an important tool in predicting mortality. Most common diagnosis was Severe Anemia and the most common cause of mortality was Hepatic encephalopathy (due to viral hepatitis). Packed RBC transfusions, mechanical ventilation and inotropic support were the commonest interventions required. Thus the causes of morbidity and mortality in this crucial subset of patients can be tackled by effective public health measures in our study population.
Keywords: Obstetric patients, Medical ICU, qSOFA score.
References
- Baskett TF, Sternadel J: Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol 1998; 105: 981–984
- Tempe A, Wadhwa L, Gupta S, et al. Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions. Indian J Med Sci. 2007;61:179e185. 2.
- Osinaike B, Amanor-Boadu S, Sanusi A. Obstetric intensive care: a developing country experience. Internet J Anesthesiol. 2006;10.
- Chawla S, Col M. Nakra , Brig S. Mohan, Col B.C. Nambiar , Col Raju Agarwal , Col A. Marwaha. Why do obstetric patients go to the ICU? A 3-year-study. medical journal armed forces india 69 (2013) 134 e137
- Devabhaktuni P, Srinivas Samavedam 2 , Gopal V. S. Thota, Saraschandrika V. Pusala1, Kasturibai Velaga1, Lavanya Bommakanti1, Clinical profile and outcome of obstetric ICU patients. APACHE II, SOFA, SAPS II and MPM scoring systems for prediction of prognosis. Open Journal of Obstetrics and Gynecology, 2013, 3, 41-50
- Bibi S, Memon A, Sheikh JM, et al. Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan. J Ayub Med Coll Abbottabad. 2008;20:109e112.
- Niyaz Ashraf, Sandeep Kumar Mishra, PankajKundra, Veena P, Soundaraghavan S, Habeebullah S; “Obstetric Patients Requiring Intensive Care: A One Year Retrospective Study in a Tertiary Care Institute in India,” Anaesthesiology Research and Practice, vol. 2014, Article ID 789450, 4 pages, 2014.
- Gupta M, Geeta Jain2, Saurabh Shukla. Evaluation of obstetric admissions to intensive care unit of a tertiary care center at Govt. medical college in Haldwani, India. Sch. J. App. Med. Sci., 2016; 4(3A):704-707
- Vasquez DN, Estenssoro E, Canales HS, Reina R, Saenz MG, Das Neves AV, et al.; Clinical characteristics and outcomes of obstetric patients requiring ICU admissions. Chest. 2007; 131:718–24.
- Kilpatrick SJ, Matthay MA; Obstetric patients requiring critical care: A five year review. Chest.1992; 101:1407–12. [PubMed: 1582306]
- Bhadade R, de’ Souza R, More A, Harde M; Maternal outcomes in critically ill obstetrics patients: A unique challenge. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 2012; 16(1): 8-16.
- Sriram S, Robertson MS. Critically ill obstetric patients in Australia: a retrospective audit of 8 years’ experience in a tertiary intensive care unit. Crit Care Resusc. 2008;10:124e128.
- Al-Suleiman SA, Qutub HO, Rahman J. Obstetric admissions to the intensive care unit: a 12-year review. Arch Gynecol Obstet. 2006;274:4e8.
- Fapronle AF, Adenekan AT; Obstetric admission into the ICU insuburban University teaching hospital, NJOG, 2011; 6(2): 33-36.
Corresponding Author
Dr Shuhaib M
P.G. Student, Department of Medicine, GR Medical College, Gwalior, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.107
