Study of obstetric patients admitted to Intensive Care Unit (ICU) at Kathmandu Medical College Teaching Hospital

Abstract

Background: Pregnancy though physiological and uneventful can be associated with major maternal morbidity with potential catastrophic consequences requiring utilization of facilities of Intensive Care Unit (ICU). Reports regarding such admissions are few from developing countries.Objective: To study the indication for admission, intervention and outcome of obstetric patients admitted to intensive care unit at Kathmandu Medical College Teaching Hospital and also to identify risk factors for admission to intensive care unit.Methods: A hospital based descriptive observational study was conducted from 1st January 2012 to 31st December 2013. All obstetric admissions to the ICU up to 42 days postpartum were included. Data obtained included demography, obstetric history, pre- existing medical problems, indication for ICU admission, intervention in ICU and outcome. Risk factors were assessed by comparing cases with control which included women who delivered before and after the indexed cases.Results: A total of 50 obstetric patients required ICU admission during the study period. This accounts for 0.87% of total hospital deliveries and 4.32% of all ICU admissions. Forty-two percent of the patients were admitted due to hypertensive disorders of pregnancy. Sixteen percent patients were of obstetric haemorrhage. Heart diseases topped the list with 16% in non-obstetric group. Risk factors for admission included lesser gestational age, Caesarean section, blood loss and co-morbid conditions of the patient. Mean age was 24.5±4.8 years; average length of stay in ICU was 3.44±3.7 days. Inotropic support was received by six patients (12%), CVP monitoring was done in three patients (6%). Ventilator support was needed in six (12%). There were three cases (6%) of mortality which accounts for 2.09% of total ICU mortality. Seventeen patients (34%) were referred from other centres.Conclusion: Hypertensive disorders of pregnancy, Obstetric haemorrhage and Heart disease were the most common indications of ICU admissions. Risk factors for admission included lesser gestational age, caesarean section, blood loss, and co- morbid conditions of the patients. Optimal outcome was achieved with combined effort of multidisciplinary team.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11777Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 196-200