Obstetric admissions to the intensive care unit
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Published on: January 16, 2019
Jamil S Anwari1, Adil A Butt, Mohammed A Al-Dar
1Department of Anesthesia and Intensive Care, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. janwari@hotmail.com
Insights
Critically ill obstetric patients admitted to the intensive care unit (ICU) primarily suffered from hemorrhage and hypertension. Invasive monitoring and ventilatory support were key interventions, highlighting the need for improved pre- and post-ICU care to reduce maternal morbidity.
Area of Science:
- Critical Care Medicine
- Obstetrics and Gynecology
- Maternal Health
Background:
- Critically ill obstetric patients require specialized intensive care unit (ICU) management.
- Understanding the characteristics and outcomes of these patients is crucial for improving care.
Purpose of the Study:
- To delineate the clinical features, interventions, and outcomes of critically ill obstetric patients admitted to a general ICU.
- To identify common indications for ICU admission and prevalent complications.
Main Methods:
- Retrospective review of medical records for 99 obstetric patients admitted to the ICU between 1997 and 2002.
- Data collection included demographics, obstetric history, medical problems, ICU admission indications, interventions, length of stay, and outcomes.
Main Results:
- Obstetric hemorrhage (32%) and hypertension (29%) were the leading admission indications.
- Most patients were postpartum, often following cesarean section; 59% had pre-existing conditions.
- Key interventions included invasive hemodynamic monitoring (arterial/central venous pressure) and ventilatory support (36%).
Conclusions:
- Hemorrhage and hypertension are the primary drivers for ICU admission in obstetric patients.
- Invasive hemodynamic monitoring and ventilatory support are the main interventions required.
- Enhancing pre- and post-ICU care quality is essential for reducing maternal morbidity and mortality.
Objective:
To describe clinical characteristics, interventions required, and outcome of critically ill obstetric patients admitted to a general intensive care unit (ICU).
Methods:
All obstetric patients admitted to ICU at Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia from 1997 to 2002 were included in the study. The data related to demographics, obstetric history, pre-existing medical problems, indications for ICU admission, intervention required, length of stay, and outcome of ICU admission were collected by retrospective review of medical records.
Results:
The 99 obstetric admissions to ICU were represented by 0.2% of all deliveries and 1.6% of all ICU admissions. Most patients were young (median age of 30 years) with parity (median) of 3 and stayed in ICU for an average of 2 days. All except one patient were admitted during the postpartum period. The majority (76%) were admitted after cesarean section. Obstetric hemorrhage (32%) and hypertension (29%) were the 2 most common indications for admission. The majority (59/99) of patients also had pre-existing medical problem and most common (16/59) was rheumatic heart disease. Preeclampsia (23/99) and eclampsia 10/99 were the most frequent obstetric complication. Thirty-six percent of our patients required ventilatory support. In the majority of patients, direct arterial (81%) and central venous (73%) pressure monitoring was carried out. Pulmonary arterial and left atrial pressure was monitored in 4%. Almost one third of patients received antihypertensive therapy. Inotropic support was given to 9% and blood (and its products) was given to 46% of patients. Antibiotics (28%) and magnesium sulphate (25%) were the most frequently used medicines. Out of the total 99 admissions, one patient died and 16 patients developed complications.
Conclusion:
In our survey, the 2 most common indications for admitting obstetric patients to ICU were hemorrhage and hypertension. Invasive hemodynamic monitoring and ventilatory support are the 2 main interventions. Improving quality of care before and after admission to ICU may reduce maternal morbidity.
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