Critical Care in Obstetrics—Where Do We Stand? A 5-Year Experience in a Tertiary Care Referral Center in India

Sudden and unexpected complication during pregnancy and childbirth is not uncommon, making intensive care unit (ICU) admission necessary. The aims and objectives of this study are to analyze the spectrum of obstetric ICU admissions and study their outcome in terms of morbidity and mortality and to suggest ways to improve critical obstetric care. The present study was a retrospective descriptive study undertaken in Kalinga Institute of Medical Science and Pradyumna Bal Memorial Hospital, Bhubaneswar, Odisha. Medical records of 53 critically ill obstetric patients admitted to the ICU from January 2010 to December 2015 were analyzed to evaluate their spectrum and outcome. Out of 4681 deliveries, 53 (1.19%) were admitted to the ICU. Mean age of the study group was 28.25 years with more of antenatal than the postnatal admissions (83.01% vs. 16.98%). Majority (83.01%) were admitted in the ICU due to obstetric cause. Hypertensive disorders of pregnancy were the leading cause ( n = 24) where preeclampsia dominates the most. The second most common cause was obstetric hemorrhage (30.18%). Of the non-obstetric causes, majority had cardiac (13%) followed by pulmonary cause (9%). The mean duration of ICU stay was 2.19 ± 1.58 days and hospital stay was 11.11 ± 13.44 days. Transfusion of blood/components was the commonest intervention (43.39%) followed by magnesium sulfate administration (32.07%) and mechanical ventilation (13.20%). There was one mortality due to septic abortion with multiorgan failure. Apart from obstetricians and intensivists, various multidisciplinary specialists were involved in the patient management. Outcome of critically ill obstetric patients is greatly influenced by early admission, proper and timely management, and multidisciplinary input in the ICU. A dedicated obstetric ICU could be an ideal setting to handle these cases.