Critical care in obstetrics - scenario in a developing country

Abstract

Objectives : To assess the maternal morbidity during pregnancy, delivery and postpartum period, needing hospitalization and admissions in intensive care unit (ICU), interventions required, and their outcome. Methods : During the three year period, from 1 st July 2002 to 30 th June 2005, 55 obstetric patients were admitted to the ICU. Cases were reviewed in detail including age, parity, reason for ICU admission, clinical features, response to interventions and maternal outcome. Results : Twenty-five antepartum, 27 postpartum, and three postabortal cases made up the total of 55 cases. Mean maternal age was 26.89±8 years, 29% were primigravidas and 71% multigravidas. The length of stay in the hospital ranged from 1 to 15 days. Severe anemia, postcesarean problems, puerperal sepsis, pregnancy induced hypertension, eclampsia, and cortical vein thrombosis were the main reasons for ICU admissions Renal failure, coagulopathy, and respiratory dysfunction were the main organ failures. All women required ventilatory support. Specialized interventions like dialysis, multiple transfusions of blood and blood products, and surgical interventions were also required. 43.63% (24/55) women died, most of them due to multi-organ dysfunction. Conclusions : Invasive hemodynamic monitoring and ventilatory support were the two main interventions. Improving quality of care before and after admission to ICU may reduce maternal morbidity.