Clinical Profile and Outcomes of Obstetric ICU Admissions in a North Indian Tertiary Care Centre: A Retrospective Study

Abstract

Background: Obstetric ICU admissions come with unique challenges due to changes in maternal physiology, fetal health, and the potential for rapid complications. Fetal well-being is often compromised along with maternal health. There is high rates of preterm delivery, low birth weight, neonatal intensive care unit (NICU) admissions born to ICU obstetric patients. Aim: This study aims to assess the clinical profiles and outcomes of obstetric patients who were admitted to intensive care. Methodology: We conducted a retrospective observational study at St Stephen’s Hospital in New Delhi, covering the period from January 2022 to December 2023. The data collected included the demographic details like age, booked or unbooked, referral status, time of admission, obstetric history, medical history, mode of delivery, diagnosis at admission, interventions, and maternal outcome. The statistical analysis was divided into descriptive analysis which included mean/median age, percentage of referrals, and frequency of specific diagnoses. Results: Out of 2010 deliveries, 37 patients (1.84%) required ICU admission, mainly due to hemorrhage and hemodynamic instability. A significant portion were unbooked (72.9%), and over half (54.05%) were referrals. Nearly 80% of these patients recovered, while the mortality rate stood at 8%. Hypertensive disorders were the second common cause for ICU admission (27.02%) with complications arising from preeclampsia, eclampsia and HELLP syndrome. This was followed by sepsis (21.6%), 8 patients requiring intensive management for septicaemia. Majority of the patients (81%) recovered in our study, 8 % improved with morbidity like dialysis dependent chronic kidney disease. This high rate of recovery is a testament of the ICU’s efficacy which demonstrates the aggressive multidisciplinary care involving the obstetricians, anesthesiologists and intensivists who successfully salvaged these patients even in the presence of severe organ failure. Conclusion: To reduce maternal morbidity and mortality, it’s crucial to enhance antenatal care, promptly identify risk factors, and implement a multidisciplinary approach in ICU management. This study helped to identify the modifiable factors like regular antenatal care, early detection of hypertensive disorders, need for anemia correction and active management of third stage, which play a significant role in the maternal outcome and will reduce the ICU admissions in obstetric patients.