Obstetric Admissions in ICU in a Tertiary Care Center: A 5-Years Retrospective Study

Obstetric admission and maternal mortality in the intensive care unit in Africa: A systematic review and meta-analysis

BACKGROUND

Obstetric complications are a major contributor to maternal morbidity and mortality worldwide, especially in low-resource settings such as many countries in Africa. Intensive care units offer specialized care for women with severe obstetric complications, which require advanced monitoring and therapeutic interventions. Despite the critical importance of ICU care, there is a paucity of comprehensive data on obstetric ICU admissions and outcomes in Africa. Therefore, this study aimed to assess the proportion of obstetric admissions and maternal mortality in the intensive care unit in Africa.

OBJECTIVE

To assess the proportion of obstetric admissions and maternal mortality in the intensive care unit in Africa.

METHODOLOGY

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020) guidelines were followed in reporting the study's findings. Articles searched; from PubMed, HINARI, Web of Science, Google Scholar, Repository, and African Journals Online were systematically searched for reports of obstetric admission in the intensive care unit, either pregnant or up to 6 weeks postpartum. The Joanna Briggs Institute (JBI) Critical Appraisal tool was used to evaluate each article's quality. The Stata 17 software was used to compute the analysis. The heterogeneity of the studies was detected using the Cochran Q test and I2 test statistics, which were considered significant at p < 0.05. The random effect model of analysis was used with evidence of heterogeneity. Egger's test at p < 0.05 was used to check the evidence of publication bias within the studies. Subgroup analysis and sensitivity analysis were done.

RESULT

Eleven studies were included in this study with a total of 10,190 mothers admitted to the intensive care unit. The overall pooled proportion of obstetric intensive care unit admissions in Africa was 17.22% (95% CI; 12.97-21.47; I2 = 97.63%). This translates to roughly 17 out of every 100 ICU admissions being for obstetric complications. Hypertensive disorders of pregnancy 42.96% (95% CI: 27.3, 58.56) and obstetric hemorrhage 24.15% (95% CI: 18.12, 30.18) were the common indications for obstetric admission in the intensive care unit.. Maternal mortality among ICU-admitted patients reached a concerning 30.69% (95% CI: 23.16, 38.22; I2= 93.34%). This means that, nearly one in three women admitted to the ICU for obstetric complications died.

CONCLUSION

In Africa, the proportion of obstetric admissions and maternal mortality in the intensive care unit is significant. This high percentage of obstetric admissions and maternal mortality in the ICU highlights the necessity to enhance emergency obstetric care services and invest in the development of well-equipped obstetric ICUs to reduce maternal mortality.

REGISTRATION

CRD42024516612.

The usefulness of a 28-item Therapeutic Intervention Scoring System (TISS-28) in critically ill obstetric patients to detect multiorgan dysfunction: A prospective cohort study

BACKGROUND

This study evaluated the effectiveness of the 28-item Therapeutic Intervention Scoring System (TISS-28) in detecting multiorgan dysfunction (MOD) among critically ill obstetric patients and compared its predictive potential to other severity models, such as Sequential Organ Failure Assessment (SOFA) and Mortality Probability Model II (MPM II).

METHODS

A prospective multicentre cohort study was conducted including obstetric patients, pregnant and up to 42 days postpartum, admitted to the intensive care units of two referral hospitals in Colombia. A total of 93 patients were recruited between March 2016 and February 2017 and from September 2019 to November 2019. Scores from the MPM II, SOFA, and TISS-28 were calculated within the first 24 h post-intensive care unit admission. The primary outcome was to evaluate the effectiveness of TISS-28 in predicting MOD, as defined by the World Health Organization near-miss criteria. We compared the TISS-28 with SOFA and MPM II scores in identifying MOD using the positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve.

RESULTS

Data from 93 patients were analysed, of whom 22 developed MOD. Hypertensive disorders were the predominant diagnosis (n = 62; 66.7%). Patients with sepsis exhibited the highest TISS-28 score, indicating more intensive therapeutic interventions. The areas under the receiver operating characteristic curve for TISS-28, SOFA, and MPM II were 0.83 (95% confidence interval: 0.73-0.92), 0.66 (0.51-0.80), and 0.59 (0.43-0.74), respectively (p = 0.001). The cut-off value of a TISS-28 score ≥21 was associated with an increased likelihood of MOD (sensitivity: 83.2%, specificity: 71.2%), a positive predictive value of 47.3%, and a negative predictive value) of 93.2%.

CONCLUSIONS

TISS-28 demonstrated robust performance in identifying MOD among obstetric patients compared to other severity indexes. The TISS-28 score complements physiology-derived severity scores by reflecting the level of care required, making it a valuable tool in risk stratification and resource allocation for critically ill obstetric patients.

Obstetric Intensive Care Admissions and Neonatal Outcomes: 15 Years of Experience from a Single Center

Background and Objectives: Maternal severe morbidity and mortality are measures for assessing maternal healthcare, and admissions to the intensive care unit (ICU) can be used to study these metrics. Here, we analyze ICU admissions of pregnant or postpartum women in a tertiary hospital. Materials and Methods: This is a retrospective, single-center, observational cohort study of obstetric intensive care admissions at a Portuguese hospital spanning 15 years. We analyzed maternal, admission-related, and neonatal variables from women admitted during pregnancy and up to 42 days post-delivery. Results: We identified 150 obstetric ICU admissions (0.9% of all ICU admissions, with an admission rate of 4.4 per 1000 deliveries). The mean age was 34 years, with most women being multiparous and 16.7% utilizing assisted reproductive technology. Notably, 45% of the women were above 35 years old. Most (86.7%) were admitted during the early postpartum period after undergoing a cesarean section (74%). The most frequent reasons for ICU admission were postpartum hemorrhage and hypertensive disorders of pregnancy. The mortality rate was 1.3%. The mean gestational age of newborns was 36 weeks and 6 days, and 46.4% were admitted to the neonatal ICU. We recorded one fetal death at 25 weeks and no neonatal deaths. Conclusions: The unique needs of obstetric ICU patients emphasize the need for specialized training of multidisciplinary teams. Severe postpartum hemorrhage was responsible for significant morbidity and disability, prompting a reassessment of delivery practices.

Clinical Characteristics of Obstetric Patients Admitted in ICU During COVID-19 Pandemic and its Comparison with Pre-COVID Period: A Retrospective Analysis from North India

Background

It was initially believed that coronavirus disease-2019 (COVID-19) increased the risk of complications as well as mortality in obstetric patients. This study was done to analyze any difference in-patient admissions, indications and outcomes in the obstetric ICU before and during the COVID-19 pandemic.

Materials and methods

A retrospective study of obstetric cases admitted to the intensive care unit over a period of 6 years was done. The 6-year period was divided into 2 groups, pre-COVID-19 era (1st March 2017-1st March 2020) and the COVID-19 pandemic (2nd March 2020-2nd March 2023). The causes of admission, clinical characteristics, interventions required and outcomes of these patients were compared to see if there was any difference between the two periods and whether COVID-19 out obstetric patients at any additional risk as compared to patients admitted during the pre-COVID-19 period.

Results

It was found that there was no significant difference in the number of admissions, associated problems, interventions required and outcomes of patients between the two groups. The data seemed to suggest that the number of abortions have increased post COVID-19, but further studies would be required for that.

Conclusion

Obstetric patients did not seem to be at an increased risk for ICU admission due to SARS-CoV-2. Furthermore, no additional increase in morbidity or mortality was observed in those patients in comparison to those admitted before the pandemic.

How to cite this article

Khan EA, Qadri A, Wani D, Gurcoo MS. Clinical Characteristics of Obstetric Patients Admitted in ICU During COVID-19 Pandemic and its Comparison with Pre-COVID Period: A Retrospective Analysis from North India. Indian J Crit Care Med 2024;28(10):912-916.

Pregnant Patients with COVID-19 Admitted to an ICU: A Comparison with a Historical Cohort of Critical Pregnant Patients without COVID-19

AIM OF THE STUDY

Maternal mortality and ICU admissions have increased during the COVID-19 pandemic. We reported a case-series of pregnant patients with COVID-19 admitted to an ICU and we compared them with a historical cohort of pregnant patients admitted to an ICU without COVID-19.

METHODS

We included all pregnant patients with laboratory-confirmed COVID-19 infection admitted to our ICU in 2021. As a historical control group, we included all pregnant women who were admitted to our ICU between 1 January 2008 and 31 December 2013.

RESULTS

In 2021, 11 pregnant patients (pts) with COVID-19 were admitted to an ICU, representing 2.87% of ICU admissions. We found that pregnant patients with COVID-19 (1) had a higher BMI (34.6 vs. 28.8, p = 0.04) and a lower gestational age (30.6 vs. 34 weeks, p = 0.03), (2) were mainly admitted for respiratory failure (100% vs. 2.7%; p = 0.001) and (3) required more days of invasive and non-invasive ventilations (54.5% vs. 5.2%, p = 0.002), a longer duration of stay at the ICU (21.9 vs. 4.8 days, p < 0.0001) and had a higher mortality rate (27.3% vs. 0%, p = 0.0192).

CONCLUSIONS

Pregnant patients with COVID-19 represent a challenge for ICU physicians due to their different characteristics and outcomes when compared to pregnant patients without COVID-19.

Prediction of Maternal Morbidity and Mortality Risk Among Women with Medical Disorders Presenting to Emergency Obstetric care (EMOC): A Prospective Observational Study

Introduction

Medical disorders complicating pregnancy have recently emerged as the most common cause for maternal morbidity and mortality and it is important to predict mortality risk when they present in moribund state to emergency obstetric care so as to take and timely effective measures to prevent mortality.

Methods

This prospective observational study was conducted over 6 months among pregnant and post-partum women with medical disorders who sought emergency obstetric care at a tertiary care hospital. Severity of morbidity was assessed using SOFA and APACHE II scores at admission.

Results

Of the 128 women, 87.5% were pregnant, and 12.5% were post-partum. Hypertensive disorders, cardiac disorders, neurological disorders and infective disorders were 24.2%, 22.6%, 14% and 9.4%, respectively. The optimal cut-off SOFA score was 2 (AUC = 0.739) with 66% sensitivity and 71% specificity and APACHE II score cut-off was 6 (AUC = 0.732) with a sensitivity of 60% and specificity of 78% in predicting severe maternal morbidity. The median scores of APACHE II and SOFA are 14 and 4, respectively, for non-survivors and for survivors it was 4 and 1.

Conclusion

Hypertensive disorder was the most common medical disorder, but severity was high in cardiac disorder. SOFA and APACHE II scores are good predictors of morbidity and mortality risk.

Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: ten years of data from a tertiary teaching hospital in mainland China

Background

Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.

Methods

The clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. PMV was defined as a mechanical ventilation length of more than 24 h. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.

Results

Out of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 h. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) =1.296, P=0.029), acute kidney injury (AKI) (OR=4.305, P=0.013), myocardial injury (OR=4.586, P=0.012), and PaO₂/FiO₂ (OR=0.989, P< 0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.

Conclusions

Estimated blood loss, AKI, myocardial injury, and PaO₂/FiO₂ were independent risk factors for PMV in critically ill obstetric patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03524-4.

Obstetric ICU: Analysing and Understanding the Data is Important

How to cite this article: Pandya ST, Mogal S, Kulkarni AP. Obstetric ICU: Analysing and Understanding the Data is Important. Indian J Crit Care Med 2019;23(5):201-202.