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Arslan K, Arslan HÇ, Şahin AS. Evaluation of critically ill obstetric patients treated in an intensive care unit during the COVID-19 pandemic. Ann Saudi Med 2023; 43:10-16. [PMID: 36739504 PMCID: PMC9899340 DOI: 10.5144/0256-4947.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although obstetric morbidity and mortality have decreased recently, rates are still high enough to constitute a significant health problem. With the COVID-19 pandemic, many obstetric patients have required treatment in intensive care units (ICU). OBJECTIVES Evaluate critical obstetric patients who were treated in an ICU for COVID-19 and followed up for 90 days. DESIGN Medical record review SETTING: Intensıve care unit PATİENTS AND METHODS: Obstetric patients admitted to the ICU between 15 March 2020 and 15 March 2022 and followed up for at least 90 days were evaluated retrospectively. Patients with and without COVID-19 were compared by gestational week, indications, comorbidities, length of stay in the hospital and ICU, requirement for mechanical ventilation, blood transfusion, renal replacement therapy (RRT), plasmapheresis, ICU scores, and mortality. MAIN OUTCOME MEASURES Clinical outcomes and mortality. SAMPLE SIZE AND CHARACTERISTICS 102 patients with a mean (SD) maternal age of 29.1 (6.3) years, and median (IQR) length of gestation of 35.0 (7.8) weeks. RESULTS About 30% (n=31) of the patients were positive for COVID-19. Most (87.2%) were cesarean deliveries; 4.9% vaginal (8.7% did not deliver). COVID-19, eclampsia/preeclampsia, and postpartum hemorrhage were the most common ICU indications. While the 28-day mortality was 19.3% (n=6) in the COVID-19 group, it was 1.4% (n=1) in the non-COVID-19 group (P<.001). The gestational period was significantly shorter in the COVID-19 group (P=.01) while the duration of stay in ICU (P<.001) and mechanical ventilation (P=.03), lactate (P=.002), blood transfusions (P=.001), plasmapheresis requirements (P=.02), and 28-day mortality were significantly higher (P<.001). APACHE-2 scores (P=.007), duration of stay in ICU (P<.001) and mechanical ventilation (P<.001), RRT (P=.007), and plasmapheresis requirements (P=.005) were significantly higher in patients who died than in those who were discharged. CONCLUSION The most common indication for ICU admission was COVID-19. The APACHE-2 scoring was helpful in predicting mortality. We think multicenter studies with larger sample sizes are needed for COVID-19 obstetric patients. In addition to greater mortality and morbidity, the infection may affect newborn outcomes by causing premature birth. LIMITATIONS Retrospectıve, single-center, small population size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Kadir Arslan
- From the Department of Anesthesiology and Intensive Care, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Hale Çetin Arslan
- From the Department of Gynecology and Obstetrics, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ayca Sultan Şahin
- From the Department of Anesthesiology and Intensive Care, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Kumar R, Gupta A, Suri T, Suri J, Mittal P, Suri JC. Determinants of maternal mortality in a critical care unit: A prospective analysis. Lung India 2022; 39:44-50. [PMID: 34975052 PMCID: PMC8926236 DOI: 10.4103/lungindia.lungindia_157_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: An admission of a pregnant woman to an intensive care unit (ICU) is considered as an objective marker of maternal near miss. Only a few studies from the Indian subcontinent have reported on the ability of ICU scoring systems in predicting the mortality in obstetric patients. Methods: A prospective analysis of all critically ill obstetric patients admitted to the critical care department was done. Results: In the period between April 2013 and September 2017, there were 101 obstetric admissions to the critical care ICU. Of these, 82 patients (81.2%) were discharged from the hospital, 18 patients (17.8%) died, and one left against medical advice. The common diagnoses seen in these patients were cardiac failure (n = 39; 38.6%); pregnancy-induced hypertension (n = 26; 25.7%); acute respiratory distress syndrome (n = 20; 19.8%); intra-abdominal sepsis (n = 19; 18.8%); tropical diseases (n = 19; 18.8%); and tuberculosis (n = 13; 12.9%). When we compared the survivors with the nonsurvivors, a higher severity of illness score and a low PaO2/FiO2 were found to increase the odds of death. The area of distribution under the receiver operator characteristic curve was 0.726 (95% confidence interval [CI] = 0.575–0.877), 0.890 (95% CI = 0.773–1.006), 0.867 (95% CI = 0.755–0.979), and 0.850 (95% CI = 0.720–0.980) for the PaO2/FiO2, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively, for predicting mortality. The standardized mortality ratio was better with SAPSII than with APACHE II. Conclusions: Cardiac dysfunction is a leading cause of ICU admission. Obstetric patients frequently require ventilatory support, intensive hemodynamic monitoring, and blood transfusion. The APACHE II score is a good index for assessing ICU outcomes.
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Affiliation(s)
- Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ayush Gupta
- Departement of Pulmonary, Critical Care and Sleep Medicine, JCS Institute of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India
| | - Tejus Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Suri
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pratima Mittal
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Jagdish Chander Suri
- Departement of Pulmonary, Critical Care and Sleep Medicine, JCS Institute of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India
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Rudakemwa A, Cassidy AL, Twagirumugabe T. High mortality rate of obstetric critically ill women in Rwanda and its predictability. BMC Pregnancy Childbirth 2021; 21:401. [PMID: 34034687 PMCID: PMC8144868 DOI: 10.1186/s12884-021-03882-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Reasons for admission to intensive care units (ICUs) for obstetric patients vary from one setting to another. Outcomes from ICU and prediction models are not well explored in Rwanda owing to lack of appropriate scores. This study aimed to assess reasons for admission and accuracy of prediction models for mortality of obstetric patients admitted to ICUs of two public tertiary hospitals in Rwanda. METHODS We prospectively collected data from all obstetric patients admitted to the ICUs of the two public tertiary hospitals in Rwanda from March 2017 to February 2018 to identify reasons for admission, demographic and clinical characteristics, outcome including death and its predictability by both the Modified Early Obstetric Warning Score (MEOWS) and quick Sequential Organ Failure Assessment (qSOFA). We analysed the accuracy of mortality prediction models by MEOWS or qSOFA by using logistic regression adjusting for factors associated with mortality. Area under the Receiver Operating characteristic (AUROC) curves is used to show the predicting capacity for each individual tool. RESULTS Obstetric patients (n = 94) represented 12.8 % of all 747 ICU admissions which is 1.8 % of all 4.999 admitted women for pregnancy or labor. Sepsis (n = 30; 31.9 %) and obstetric haemorrhage (n = 24; 25.5 %) were the two commonest reasons for ICU admission. Overall ICU mortality for obstetric patients was 54.3 % (n = 51) with average length of stay of 6.6 ± 7.525 days. MEOWS score was an independent predictor of mortality (adjusted (a)OR 1.25; 95 % CI 1.07-1.46) and so was qSOFA score (aOR 2.81; 95 % CI 1.25-6.30) with an adjusted AUROC of 0.773 (95 % CI 0.67-0.88) and 0.764 (95 % CI 0.65-0.87), indicating fair accuracy for ICU mortality prediction in these settings of both MEOWS and qSOFA scores. CONCLUSIONS Sepsis and obstetric haemorrhage were the commonest reasons for obstetric admissions to ICU in Rwanda. MEOWS and qSOFA scores could accurately predict ICU mortality of obstetric patients in resource-limited settings, but larger studies are needed before a recommendation for their use in routine practice in similar settings.
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Affiliation(s)
- Alcade Rudakemwa
- Ruhengeri Referral Hospital , North Province, Ruhengeri, Rwanda.
| | - Amyl Lucille Cassidy
- Department of Anesthesiology, Wake Forest University School of Medicine, North Carolina, Winston-Salem, USA
| | - Théogène Twagirumugabe
- College of Medicine and Health Sciences, University of Rwanda, University Teaching Hospital of Butare, Butare, Rwanda
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Gupta H, Gandotra N, Mahajan R. Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Center in North India. Indian J Crit Care Med 2021; 25:388-391. [PMID: 34045804 PMCID: PMC8138638 DOI: 10.5005/jp-journals-10071-23775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Critically ill obstetric patients constitute a small number of intensive care unit (ICU) admissions. Physiological changes in pregnancy along with certain pregnancy-specific diseases may cause a rapid worsening of the health status of the patient necessitating ICU care. The present study aims to study the clinical profile of the obstetric patients requiring ICU care. Materials and methods It was a retrospective analysis of pregnant/postpartum (up to 6 weeks) admissions over a period of 18 months. Results Over these 18 months, 127 women required ICU admission. The most common reasons for ICU admission were obstetric hemorrhage (37.79%) and (pre)eclampsia (28.35%). Ten patients presented with antepartum hemorrhage (placenta previa, placenta accreta, placenta increta). The rest of the patients (n = 38) had atonic postpartum hemorrhage with five having severe anemia. Among the nonobstetric causes (n = 26/127), ICU admission was the most common among those with preexisting heart diseases (n = 10; 7.87%). Forty-nine patients were ventilated mechanically (38.58%), with eclampsia being the most common primary diagnosis (n = 23). We observed 10 maternal deaths (7.87%) with septicemia being the most important cause of death. Conclusions Maternal and child health has become an important measure of human and social development. Early diagnosis and prompt treatment of high-risk obstetric patients in a dedicated obstetric ICU in tertiary hospitals can prevent severe maternal morbidity and improve maternal care. How to cite this article Gupta H, Gandotra N, Mahajan R. Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Center in North India. Indian J Crit Care Med 2021;25(4):388–391.
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Affiliation(s)
- Heena Gupta
- Department of Anesthesiology and Critical Care, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Nikita Gandotra
- Department of Obstetrics and Gynaecology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Ruhi Mahajan
- Department of Biochemistry, Government Medical College, Jammu, Jammu and Kashmir, India
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Suri J, Kumar R, Gupta A, Mittal P, Suri JC. A Prospective Study of Clinical Characteristics and Interventions Required in Critically Ill Obstetric Patients. Indian J Crit Care Med 2020; 24:677-682. [PMID: 33024374 PMCID: PMC7519589 DOI: 10.5005/jp-journals-10071-23519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Obstetric patients are a special group of patients whose management is challenged by concerns for fetal viability, altered maternal physiology, and diseases specific to pregnancy. Materials and methods A prospective analysis of all obstetric patients admitted to the critical care department was done to assess reasons for transfer to the critical care unit (CCU) and the interventions required for management of these patients. Results Between June 2013 and September 2017, obstetric admission comprised 95 women (5.9%) of the total critical care admissions. There were 77 patients (81.1%) who were discharged from the hospital and 18 patients (18.9%) died. In most of the cases, the primary reasons for shifting the patient to the CCU were severe preeclampsia with pulmonary edema (22.1%), eclampsia (8.4%), acute respiratory distress syndrome (ARDS) (14.7%), and hypovolemic shock in antepartum hemorrhage (APH) and postpartum hemorrhage (PPH) (10.5 and 13.7%, respectively). It was seen that 73 patients (76.8%) required ventilator support, 58 patients (57.4%) required vasopressor support, and intensive hemodynamic monitoring and blood/blood products were transfused in 55 patients (54.5%). The need for ventilator support was more in patients with a lower PaO2/FiO2 and a higher APACHE II score. Patients with a high severity of illness score and a lower PaO2/FiO2 had higher odds of requiring vasopressors. Low hemoglobin at the time of transfer to the CCU and a prolonged hospital stay were found to predict the need for blood transfusion. Conclusion Obstetric patients are susceptible to critical illnesses but timely management improves the outcome of these young women. How to cite this article Suri J, Kumar R, Gupta A, Mittal P, Suri JC. A Prospective Study of Clinical Characteristics and Interventions Required in Critically Ill Obstetric Patients. Indian J Crit Care Med 2020;24(8):677–682.
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Affiliation(s)
- Jyotsna Suri
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ayush Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Jagdish C Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Vargas M, Marra A, Buonanno P, Iacovazzo C, Schiavone V, Servillo G. Obstetric Admissions in ICU in a Tertiary Care Center: A 5-Years Retrospective Study. Indian J Crit Care Med 2019; 23:213-219. [PMID: 31160837 PMCID: PMC6535986 DOI: 10.5005/jp-journals-10071-23163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and Aim Obstetric patients admitted to intensive care unit (ICU) represent a challenge to physicians. The purpose of this study is to evaluate the incidence, characteristics, and mortality of pregnant and postpartum patients requiring ICU admission. Materials and Methods A retrospective cohort study was performed between January 2008 and December 2013 at the University Hospital Federico II of Naples including pregnant and puerperal women until the 42nd day of postpartum and admitted to ICU. Results Patients admitted with an obstetric diagnosis had a higher incidence of at least one previous cesarean section, were treated more with hysterectomy, had an increasing incidence of hemodynamic instability, had more postpartum admission, had a higher TISS-28 score, and required more endotracheal intubation than patients admitted with non-obstetrics diagnosis. Conclusion A shared approach including a close collaboration between ICU and obstetric ward may be useful to reduce ICU admission and to improve maternal and foetal outcomes. How to cite this article Vargas M, Marra A, Buonanno P, Iacovazzo C, Schiavone V, Servillo G. Obstetric Admissions in ICU in a Tertiary Care Center. A 5-years Retrospective Study. Indian J Crit Care Med 2019;23(5):213-219.
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Schiavone
- Department of Anesthesia and Intensive Care, Pineta Grande Clinic, Caserta, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Aoyama K, D’Souza R, Pinto R, Ray JG, Hill A, Scales DC, Lapinsky SE, Seaward GR, Hladunewich M, Shah PS, Fowler RA. Risk prediction models for maternal mortality: A systematic review and meta-analysis. PLoS One 2018; 13:e0208563. [PMID: 30513118 PMCID: PMC6279047 DOI: 10.1371/journal.pone.0208563] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/19/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Pregnancy-related critical illness leads to death for 3-14% of affected women. Although identifying patients at risk could facilitate preventive strategies, guide therapy, and help in clinical research, no prior systematic review of this literature exploring the validity of risk prediction models for maternal mortality exists. Therefore, we have systematically reviewed and meta-analyzed risk prediction models for maternal mortality. METHODS Search strategy: MEDLINE, EMBASE and Scopus, from inception to May 2017. Selection criteria: Trials or observational studies evaluating risk prediction models for maternal mortality. Data collection and analysis: Two reviewers independently assessed studies for eligibility and methodological quality, and extracted data on prediction performance. RESULTS Thirty-eight studies that evaluated 12 different mortality prediction models were included. Mortality varied across the studies, with an average rate 10.4%, ranging from 0 to 41.7%. The Collaborative Integrated Pregnancy High-dependency Estimate of Risk (CIPHER) model and the Maternal Severity Index had the best performance, were developed and validated from studies of obstetric population with a low risk of bias. The CIPHER applies to critically ill obstetric patients (discrimination: area under the receiver operating characteristic curve (AUC) 0.823 (0.811-0.835), calibration: graphic plot [intercept-0.09, slope 0.92]). The Maternal Severity Index applies to hospitalized obstetric patients (discrimination: AUC 0.826 [0.802-0.851], calibration: standardized mortality ratio 1.02 [0.86-1.20]). CONCLUSIONS Despite the high heterogeneity of the study populations and the limited number of studies validating the finally eligible prediction models, the CIPHER and the Maternal Severity Index are recommended for use among critically ill and hospitalized pregnant and postpartum women for risk adjustment in clinical research and quality improvement studies. Neither index has sufficient discrimination to be applicable for clinical decision making at the individual patient level.
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Affiliation(s)
- Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Rohan D’Souza
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Joel G. Ray
- Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrea Hill
- Department of Critical Care Medicine, Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Damon C. Scales
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Stephen E. Lapinsky
- Department of Critical Care Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
| | - Gareth R. Seaward
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Prakesh S. Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Departments of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Robert A. Fowler
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Science Center, Toronto, ON, Canada
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Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center. Obstet Gynecol Sci 2018; 61:209-219. [PMID: 29564311 PMCID: PMC5854900 DOI: 10.5468/ogs.2018.61.2.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 11/08/2022] Open
Abstract
Objective Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women. Methods Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994-2004; period 2: 2005-2015) and place of delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used to evaluate the usefulness of APACHE II score to predict maternal mortality. Results During 22-year period, 176 women required ICU admission, showing the incidence of 2.2 per 1,000 deliveries. The most common reason for ICU admission was postpartum hemorrhage (56.3%), followed by hypertensive disorders (19.3%), sepsis (3.4%), and pulmonary and amniotic fluid embolism (2.3%). Period 2 showed older maternal age (32.7±4.8 vs. 30.8±4.4 years, P=0.006, higher embolization rate (26.4% vs.1.2%, P<0.001), and lower hysterectomy rate (30.8% vs. 49.4%, P=0.012). Cases from local hospitals showed significantly higher proportion of postpartum hemorrhage (84.5% vs. 42.2%, P<0.001). Overall maternal death occurred in 5.1% (9/176) including 6 direct maternal deaths. The APACHE II score showed area under the ROC curve of 0.813 (confidence interval [CI], 0.607-1.000) for prediction of maternal mortality. Conclusion The incidence of obstetric ICU admission was 2.2 per 1,000 deliveries and the most common reason was postpartum hemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.
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Ozumba BC, Ajah LO, Obi VO, Umeh UA, Enebe JT, Obioha KC. Pattern and Outcome of Obstetric Admissions into the Intensive Care Unit of a Southeast Nigerian Hospital. Indian J Crit Care Med 2018; 22:16-19. [PMID: 29422727 PMCID: PMC5793016 DOI: 10.4103/ijccm.ijccm_297_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Although pregnancy and labor are considered physiological processes, the potential for catastrophic complications is constant and may develop rapidly. There is growing evidence that admission of high-risk patients into the Intensive Care Unit (ICU) is associated with a reduction in maternal mortality. This study was aimed at reviewing all obstetric patients admitted into the ICU. Materials and Methods: This was a retrospective study of all obstetric patients who were admitted into the ICU between January 1, 2012, and December 31, 2013. Results: There were 89 obstetric patients admitted and managed at the ICU out of 5176 deliveries, thereby accounting for 1 admission in 58 deliveries. Majority of the patients were between 26 and 30 years, primiparous, and unbooked. The indications for ICU admission in this study were ruptured uterus (36.0%), eclampsia (22.5%), obstetric hemorrhage (19.1%), septicemia (10.1%), severe preeclampsia (6.7%), and obstructed labor (6.7%). The maternal and perinatal mortality was 13.5% and 47.2%, respectively. Maternal unbooked status was significantly associated with maternal mortality (P < 0.05). Conclusion: Ruptured uterus was the most common indication for ICU admission in the center. Maternal mortality was significantly associated with unbooked status. This underscores the importance of booking for antenatal care, prompt presentation at the hospital during emergencies, skilled birth attendance, and provision of adequate facilities for the management of critical obstetric cases in this environment.
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Affiliation(s)
- Benjamin Chukwuma Ozumba
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Leonard Ogbonna Ajah
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Vitus Okwuchukwu Obi
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Uche Anthony Umeh
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Joseph Tochukwu Enebe
- Department of Obstetrics and Gynaecology, ESUT Teaching Hospital, Park Lane, Enugu, Nigeria
| | - Kingsley Chukwu Obioha
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Özçelik M, Turhan S, Bermede O, Yılmaz AA, Ünal N, Bayar MK. Outcomes of Antepartum and Postpartum Obstetric Admissions to the Intensive Care Unit of A Tertiary University Hospital: An 8-Year Review. Turk J Anaesthesiol Reanim 2017; 45:303-309. [PMID: 29114416 DOI: 10.5152/tjar.2017.56323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/28/2017] [Indexed: 12/29/2022] Open
Abstract
Objective Although their rates are decreasing, pregnancy-related mortality and morbidity are problems worldwide. In this study, we aimed to review the characteristics, diagnoses, required interventions and outcomes of obstetric patients admitted between 2006 and 2014 to the Intensive Care Unit (ICU) of a tertiary university hospital to provide an indicator for improving the management of critically ill obstetric patients. Methods A retrospective study of hospital records of obstetric admissions to the ICU was conducted. Results The pregnancy-related ICU admission rate was 0.21% among all deliveries during the study period. Nine antepartum (mean gestational age: 23 weeks) and 48 postpartum (mean gestational age: 34 weeks) obstetric ICU admissions were included. Most obstetric patients admitted antepartum were primiparous (88.8%), whereas those admitted postpartum were multiparous (64.6%). The mean ICU stay was 7 days among the patients admitted antepartum and 6 days among those admitted postpartum. Common medical reasons for ICU admission were respiratory failure and HELLP syndrome in both groups; DIC and eclampsia were also medical reasons causing ICU admission among the postpartum patients. Mechanical ventilation and blood derivative transfusion were the most common interventions required during the ICU stay of the obstetric patients. Maternal death was unique to the patients admitted postpartum (6 patients, 12.5%). Conclusion We reviewed obstetric admissions to our institution over an 8-year period. We believe that a nationwide study in Turkey that provides an indicator of the frequency, reasons of ICU admission and outcome of obstetric patients is required to improve the quality of intensive care.
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Affiliation(s)
- Menekşe Özçelik
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Sanem Turhan
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Onat Bermede
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Abbas Yılmaz
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Necmettin Ünal
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kemal Bayar
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
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Farzi F, Mirmansouri A, Atrkar Roshan Z, Naderi Nabi B, Biazar G, Yazdipaz S. Evaluation of Admission Indications, Clinical Characteristics and Outcomes of Obstetric Patients Admitted to the Intensive Care Unit of a Teaching Hospital Center: A Five-Year Retrospective Review. Anesth Pain Med 2017; 7:e13636. [PMID: 29181330 PMCID: PMC5696879 DOI: 10.5812/aapm.13636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/01/2017] [Accepted: 04/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background Care of obstetric patients has always been a challenge for critical care physicians, because in addition to their complex pregnancy-related disease, fetal viability is considered. Objectives The aim of this study was to review the admission indications, clinical characteristics and outcomes of obstetric patients, admitted to the intensive care unit of Alzzahra teaching hospital affiliated to Guilan University of Medical Sciences, Rasht, Iran. Methods This retrospective cohort study was conducted on pregnant /post-partum (up to 6 weeks) patients admitted to the ICU over a 5-year period from April 2009 to April, 2014. Results Data from 1019 subjects were analyzed. Overall, 90.1% of the patients were admitted in the postpartum period. The most common indications for admission were pregnancy related hypertensive disorders (27.5%) and obstetric hemorrhage (13.5%). Epilepsy (5.4%) and cardiac disease (5.2%) were the most common non-obstetric indications. Conclusions Pregnancy-related hypertensive disorders and obstetric hemorrhage were the main reasons for admission, and epilepsy and cardiac disease were the most common non-obstetric indications. Efforts must be concentrated on increasing antenatal care.
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Affiliation(s)
- Farnoush Farzi
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mirmansouri, Anesthesiology Research Center, Velayat Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran. Tel: +98-9111315314, E-mail:
| | - Zahra Atrkar Roshan
- Department of Statistically, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Biazar
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shima Yazdipaz
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Dasgupta S, Jha T, Bagchi P, Singh SS, Gorai R, Choudhury SD. Critically Ill Obstetric Patients in a General Critical Care Unit: A 5 Years' Retrospective Study in a Public Teaching Hospital of Eastern India. Indian J Crit Care Med 2017; 21:294-302. [PMID: 28584433 PMCID: PMC5455023 DOI: 10.4103/ijccm.ijccm_445_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Critical care services are essential for the subset of obstetric patients suffering from severe maternal morbidity. Studies on obstetric critical care are important for benchmarking the issues which need to be addressed while managing critically ill obstetric patients. Although there are several published studies on obstetric critical care from India and abroad, studies from Eastern India are limited. The present study was conducted to fill in this lacuna and to audit the obstetric critical care admissions over a 5 years’ period. Settings and Design: Retrospective cohort study conducted in the general critical care unit (CCU) of a government teaching hospital. Materials and Methods: The records of all obstetric patients managed in the CCU over a span of 5 years (January 2011-December 2015) were analyzed. Results: During the study, 205 obstetric patients were admitted with a CCU admission rate of 2.1 per 1000 deliveries. Obstetric hemorrhage (34.64%) was the most common primary diagnosis among them followed by pregnancy-induced hypertension (26.83%). Severe hemorrhage leading to organ failure (40.48%) was the main direct indication of admission. Invasive ventilation was needed in 75.61% patients, and overall obstetric mortality rate was 33.66%. The median duration (in days) of invasive ventilation was 2 (interquartile range [IQR] 1-7), and the median length of CCU stay (in days) was 5 (IQR 3-9). Conclusions: Adequate number of critical care beds, a dedicated obstetric high dependency unit, and effective coordination between critical care and maternity services may prove helpful in high volume obstetric centers.
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Affiliation(s)
- Sugata Dasgupta
- Department of Anesthesiology and Critical Care Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Tulika Jha
- Department of Gynecology and Obstetrics, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Priyojit Bagchi
- Department of Anesthesiology and Critical Care Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Shipti Sradha Singh
- Department of Anesthesiology and Critical Care Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ramprasad Gorai
- Department of Anesthesiology and Critical Care Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sourav Das Choudhury
- Department of Critical Care Medicine, Gitaram Hospital, Murshidabad, West Bengal, India
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Bayes S, Ewens B. Registered nurses' experiences of caring for pregnant and postpartum women in general hospital settings: a systematic review and meta-synthesis of qualitative data. J Clin Nurs 2016; 26:599-608. [PMID: 27534927 DOI: 10.1111/jocn.13524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To understand how nurses view and experience caring for pregnant and postpartum women in nonmaternity care settings. BACKGROUND A degree of apprehension is perceived to exist among nurses in relation to caring for pregnant or postpartum women in nonmaternity care settings. The nature of nonmidwife nurses' concerns about caring for this group of women in these contexts, however, is not known. DESIGN A six-step systematic approach was employed for this review. METHODS In Step 1, the research question was developed; Step 2 involved developing the inclusion criteria for articles; the literature search strategy was devised in Step 3; Step 4 comprised the conduct of the literature search and selection of articles for review; in Step 5, the critical appraisal of selected studies and synthesis of data was undertaken; interpretation of the findings occurred in Step 6. RESULTS Following a process of elimination, the final number of articles retained for this review was three. Fifty-four Level 1 findings were extracted from these three articles which were subsequently collapsed into four Level 2 categories. Two Level 3 synthesised findings that characterise what is known about the topic of interest were then derived from these four Level two categories. CONCLUSIONS Nurses are reportedly ill prepared for the experience of caring for pregnant and postpartum women in general care settings. A combination of a lack of education and a need to 'learn on the job' reportedly evokes stress, trauma and a sense of professional inadequacy. RELEVANCE TO CLINICAL PRACTICE This review identifies lack of knowledge and of adequate supervision for nurses in this context, which in turn poses a clinical risk to pregnant and postpartum women in their care. Effective strategies to establish initial and ongoing collaborative education and clinical practice guidelines are required.
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Affiliation(s)
- Sara Bayes
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
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Rathod AT, Malini KV. Study of Obstetric Admissions to the Intensive Care Unit of a Tertiary Care Hospital. J Obstet Gynaecol India 2015; 66:12-7. [PMID: 27651571 DOI: 10.1007/s13224-015-0750-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/10/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To analyze obstetric admissions to intensive care unit and to identify the risk factors responsible for intensive care admission. METHODS This is a retrospective study of all obstetric cases admitted to the intensive care unit over a period of 3 years. Data were collected from case records. The risk factors responsible for ICU admission were analyzed. RESULTS There were 765 obstetric admissions to ICU accounting for 1.24 % of all deliveries. 56.20 % were in the age group of 20-25 years. 38.43 % were in their first pregnancy. 36.48 % of cases were at 37-40 weeks of gestation. Postpartum admissions were 80.91 %. Major conditions responsible were obstetric hemorrhage in 44.05 %, hypertensive disorders of pregnancy in 28.88 %, severe anemia in 14.37 %, heart disease in 12.15 %, and sepsis in 7.97 % of ICU cases. 40.39 % cases required high dependency care. Maternal mortality was seen in 15.55 % of ICU cases. Commonest cause of mortality was hemorrhagic shock (26.89 %) and multiorgan dysfunction syndrome (26.05 %). CONCLUSION Commonest risk factors for ICU admissions are obstetric hemorrhage and hypertensive disorders of pregnancy. Other major risk factors are severe anemia, heart disease, sepsis, more than one diagnosis on admission, and the need for cesarean delivery.
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Affiliation(s)
- Ashakiran T Rathod
- Department of Obstetrics and Gynecology, Bangalore Medical College and Research Institute, No. 620, A4 Block, Krishna Block, National Games Village, Koramangala, Bangalore, Karnataka 560047 India
| | - K V Malini
- Department of Obstetrics and Gynecology, Bangalore Medical College and Research Institute, No. 620, A4 Block, Krishna Block, National Games Village, Koramangala, Bangalore, Karnataka 560047 India
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Gombar S, Ahuja V, Jafra A. A retrospective analysis of obstetric patient's outcome in intensive care unit of a tertiary care center. J Anaesthesiol Clin Pharmacol 2014; 30:502-7. [PMID: 25425775 PMCID: PMC4234786 DOI: 10.4103/0970-9185.142843] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background and Aims: Admission to an intensive care unit (ICU) is considered as an objective marker of severe maternal morbidity. The aim was to assess the incidence and possible risk factors of obstetric patient admissions in the multidisciplinary ICU of a tertiary care center with emphasis on standardized mortality ratio (SMR). Material and Methods: A retrospective five year ICU record analysis was done for all pregnant women, who were admitted to multidisciplinary ICU of a tertiary care hospital during June 2007-12. Results: During this 5-year period, 21,943 deliveries took place and 164 women required ICU admission. Out of these, the data of 151 patients were analyzed. Maternal mortality rate was 31.1% (47 deaths) for patients admitted to ICU. The simplified acute physiologic score (SAPS) II was 62 (55-68) in nonsurvivor versus 34.00 (28-46) in survivor group (P value < 0.001). The receiver operated characteristic curve was plotted using SAPS II scores and the area under the curve was 0.93 with 95% confidence interval (0.89-0.96). The calculated SMR was 0.97. Conclusions: Women admitted to ICU with diagnosis of puerperal sepsis and intrauterine death (IUD) with coexisting sepsis had higher mortality as compared to women with hypertensive disease of pregnancy and hemorrhage. The calculated SMR was less than one which is a predictor of good ICU care.
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Affiliation(s)
- Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Anudeep Jafra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
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Souza JP, Cecatti JG, Haddad SM, Parpinelli MA, Costa ML, Katz L, Say L. The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity. PLoS One 2012; 7:e44129. [PMID: 22952897 PMCID: PMC3430678 DOI: 10.1371/journal.pone.0044129] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 08/01/2012] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. METHODS In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. RESULTS Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993)). CONCLUSION The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.
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Affiliation(s)
- Joao Paulo Souza
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Andrade Lima Coêlho MD, Katz L, Coutinho I, Hofmann A, Miranda L, Amorim M. Perfil de mulheres admitidas em uma UTI obstétrica por causas não obstétricas. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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