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Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan
Rahat Qureshi1, Sheikh Irfan Ahmed1, Amir Raza2
1Department of Obstetrics and Gynecology, Aga Khan University and Hospital, Karachi, 3500, Pakistan.
Insights
Obstetric intensive care unit admissions reveal high rates of organ system failure and mortality, particularly with gastro-intestinal complications. Vigilance and stabilization of high-risk pregnancies improve outcomes.
Area of Science:
- Obstetrics and Gynecology
- Critical Care Medicine
- Maternal Health
Background:
- Obstetric admissions to the intensive care unit (ICU) represent severe maternal morbidity.
- Understanding the characteristics and outcomes of these critically ill obstetric patients is crucial for improving care.
Purpose of the Study:
- To review obstetric cases admitted to the intensive care unit.
- To identify diagnoses, risk factors, management, and mortality rates in critically ill obstetric patients.
Main Methods:
- A ten-year retrospective review of medical records for obstetric patients admitted to the ICU.
- Data collected included diagnosis, risk factors, interventions, and mortality.
- Study conducted at Aga Khan University Hospital, Karachi, from 2005-2014.
Main Results:
- 194 obstetric patients were admitted to the ICU, with 86.2% requiring ventilator support.
- The overall mortality rate was 21.64%. Gastro-intestinal complications significantly increased mortality risk (OR=4.87).
- The most common diagnoses were hematological (28.4%), followed by postpartum hemorrhage, hypertensive disorders, and sepsis.
Conclusions:
- Key indications for ICU admission included postpartum hemorrhage, hypertensive disorders, sepsis, and infections.
- Increased vigilance and pre-intervention stabilization are vital for improving outcomes in high-risk obstetric patients requiring critical care.
Objective:
Review of obstetric cases admitted to the intensive care unit.
Design:
Ten year retrospective review of individual patients' medical records.
Participants:
Records of obstetric patients admitted from 2005-2014.
Setting:
Aga Khan University Hospital Karachi.
Main Outcome Measures:
Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings:
A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay was 24 hours and maximum stay was 53 days. Sixty one percent of patients were admitted to with organ system failure. The overall mortality rate was 21.64% (42/194). The mortality rate was five times more likely in patients who had gastro-intestinal complication {Odds Ratio=4.87; 95%CI: 1.65-14.36}. The largest group of patients {28.4%} presented with hematological diagnosis.
Conclusion:
When the intensive care unit admission became essential, primary diagnosis included: postpartum hemorrhage, hypertensive disorders, sepsis and infectious diseases. An increased vigilance of high-risk pregnant women and a stabilization of their condition before intervention is administered, improves the outcome of these women.