Obstetric admissions to the intensive care unit of a tertiary hospital in northern India

Abstract

Objective : To determine the causes of the obstetric admissions to the intensive care unit (ICU) and the impact of antenatal care on ICU admission. Methods : Obstetric ICU admissions over the two years from May 2009 to May 2011 at Maulana Azad Medical College and associated Lok Nayak Hospitals, New Delhi, were analyzed retrospectively. Results : The 136 obstetric admissions to the ICU represented 0.8% of all the deliveries in the hospital during that period. The majority (76%) of women were transferred to the ICU postpartum. Obstetric haemorrhage(56.1%), hypertension(19.8%), and endotoxic shock(12.5%) were the major obstetric cause of the ICU admission. Together with the cardiac disease, DIC, infections, they formed 91.4% of all the admissions. Anaesthetic complications were responsible for 2.9% of them. Of all the admissions, 12% were completely unbooked and uninvestigated during the whole antenatal period, 85% were registered/ booked at other hospitals and 3% were booked in our hospital. The maternal mortality was 19.1% of all the ICU admissions in this study, and the mortality rate in unbooked patients was 58%. Conclusion : The most common precipitants of ICU admission were obstetric haemorrhage and uncontrolled hypertension, both of which can be managed well if the patient has complete antenatal visits and investigations. This reflects the importance of ante-natal care, so that the high risk pregnant female can be identified in advance, referred at appropriate time to the higher centre and managed meticulously.