Obstetric patients requiring high-dependency unit admission in a tertiary referral centre

To analyze the HDU requirement in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome.

A retrospective observational study was carried out from May 2007 to May 2011 in the Dept. of Obstetrics and Gynecology and HDU of IPGME and R, Kolkata.

Data related to obstetric history, pre-existing medical problems, indications for HDU admission, interventions required, length of stay and outcome were collected and results were analyzed.

Our obstetric HDU utilization rate was 11.2 per 1000 deliveries. Out of total 57 subjects 48 had no prior antenatal care. Majority (68.42%) admitted in HDU with only obstetric reasons, while 31.57% required HDU for pre-existing medical diseases. The major obstetric indications were septicemia (35.08%), PPH (29.08%) and hypertension was observed in 21.05% of women. Other less common causes included post surgical acute kidney injury, APH, chrioamnionitis and pyelonephritis. Half of the women with pre-existing medical disease had cardiovascular problems. Patients with medical diseases had more pre-term labor (10 vs 5; P ≤ 0.05), respiratory failure (9 vs 2; P ≤ 0.05), cardiac failure (7 vs 1; P ≤ 0.05), duration of stay more than 10 days (15 vs 6; P ≤ 0.05), fetal growth restriction (6vs 3; P ≤ 0.05) and prolonged recovery time. Maternal mortality was 12.28% and fetal mortality was 17.54%.

Early screening of high risk mothers, vigilant antenatal care and proper maintenance of asepsis during delivery and postpartum period can reduce HDU utilization rate and can result in healthier outcome.