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Obstetric and gynaecological patients in an intensive care unit: a 1 year review
P Platteau1, T Engelhardt, J Moodley
1Department of Obstetrics & Gynaecology, University of Natal, Congella, South Africa.
Insights
Critically ill obstetric and gynaecological patients, especially those with eclampsia, represent a significant ICU workload. Establishing dedicated ICUs in obstetrics units can improve care and training in developing countries.
Area of Science:
- Obstetrics and Gynecology
- Critical Care Medicine
- Public Health
Background:
- Management of critically ill obstetric and gynaecological (O & G) patients is a substantial part of O & G practice.
- Limited reports exist on the specific management of these patients within intensive care units (ICUs).
Purpose of the Study:
- To review O & G patients admitted to a surgical ICU and provide recommendations for their management.
- To analyze the characteristics and outcomes of O & G patients in the ICU.
Main Methods:
- Retrospective analysis of medical records for all O & G patients admitted to the surgical ICU at King Edward VIII Hospital, Durban, South Africa.
- Data collected for admissions between January and December 1992.
Main Results:
- O & G patients constituted 13.6% of all ICU admissions (n=122).
- Eclampsia was the leading diagnosis, accounting for 66% of obstetric admissions, with 24% of eclamptic patients requiring ICU admission.
- The overall maternal mortality rate for O & G patients in the ICU was 21%.
Conclusions:
- O & G patients, particularly those with eclampsia, represent a significant patient load for surgical ICUs.
- Effective management necessitates a thorough understanding of pregnancy-related physiological changes.
- Developing countries' large obstetrical units should consider establishing dedicated ICUs to enhance patient care, training, and education.
Abstract:
Management of the critically ill patient forms a significant proportion of obstetric and gynaecological (O & G) practice. There have however, been very few reports on the management of such patients in intensive care units (ICU). We review all O & G patients admitted to the surgical ICU at King Edward VIII Hospital, Durban, South Africa, and make recommendations regarding management of such patients. The medical records of all O & G patients admitted to the surgical ICU between the period January-December 1992 were analysed. Of all admissions to the ICU 13.6% (n = 122) were O & G patients. Eclampsia was the most common diagnosis accounting for 66% of all obstetric admissions. Of all eclamptics in the study period 24% were admitted to the ICU. The overall maternal mortality was 21%. O & G patients form a major workload of surgical ICUs and the majority of these patients are women with eclampsia. Management of such patients requires an understanding of the physiological changes of normal and abnormal pregnancies. Therefore, all large obstetrical units in developing countries should establish their own ICU in order that patient care, health personnel training and continuing health care education may be improved.