Critical Care of Gynecological and Obstetric Patients: A decade of surgical intensive care experience

Abstract

Despite the emergence of therapeutic advances, the morbidity and mortality still occur in the obstetric patients, although intensive care utilization by obstetric and gynecological patient, are still rare compared to the general population. Majority of obstetric patients needed the intensive care therapy compared to gynecological patients. The aim of our study was to know the indications for the intensive care admission by obstetric and gynecological patients, length of stay and outcome of these patients. Methods: We retrospectively reviewed the medical records of all obstetric and gynecological patients admitted to our Surgical and Trauma Intensive Care Units (SICU and TICU) from February 1995 to March 2005. Indication for admission, nationality, age, and length of stay in ICU, severity of disease and outcome of these patients were recorded. Data analyzed with SPSS program. Results: A total of 182 patients were admitted to the SICU of the Hamad Medical Corporation in Doha, Qatar, from the Women's Hospital. 159 (87%) patients were obstetric patients and 23 (13%) patients gynecological patients, 126 (69.6%) patients were admitted post Lower Segment Caesarean Section (LSCS). The most common indication for admission was 73 (39.3%) patients obstetric hemorrhage and Disseminated Intravascular Coagulation (DIC), and then 44 (25.3%) patients of hypertensive disorder of pregnancy. The major anesthesia related indication was scoline apnea, 21 (11.6%). Total three obstetric patients died, two due to severe sepsis and multi-organ failure and one due to cerebral sinus thrombosis, giving mortality rate of 1.66%. Conclusion: Intensive care therapy required by gynecological and obstetric patient is less than the general population. The commonest indication for admission was obstetric hemorrhage, DIC, and hypertensive disorders of pregnancy. The mortality was due to septic shock with multi-organ failure, and cerebral venous sinus thrombosis.