Maternal demography, clinical characteristics, & outcomes at an obstetric intensive care unit of a tertiary-care teaching maternity hospital in the Kashmir Valley.

Abstract

Background & objectives Obstetric patients often need admission to intensive care units (ICUs). The data on these patients are scarce and heterogeneous. We studied the profile of obstetric patients admitted to our ICU. Methods The records of obstetric patients admitted to the ICU at the Government Lalla Ded Hospital, Srinagar, Jammu and Kashmir, India, dedicated to obstetrics and gynaecology patients, were analysed retrospectively from March 2022 to February 2023.This included demography, co-morbidities, pre-admission surgeries/procedures, clinical characteristics, and outcomes (death/discharge/transfer). Results Out of 525 obstetric ICU patients, the majority were admitted for obstetric causes (94.66%) and after surgery (84.38%), mostly (66.59%) after caesarean section (CS). Hypertension (35.23%) and anaemia (32.76%) were the most common co-morbidities. The majority were admitted for hypertensive disorders of pregnancy (HDP; 34.47%) or post-partum haemorrhage (PPH; 24.71%) or complications. Only two per cent of CS and one per cent of vaginal delivery (VD) patients needed ICU admission. The maternal ICU mortality rate was 6.53 per cent (0.15% of total deliveries). Only 6.66 per cent needed transfer to non-obstetric or multi-specialty care. Admission with heart disease [Hazard ratio; HR=8.26, 95% Confidence interval (CI)=0.01-67.17,P<0.05], after intra-uterine foetal death (IUFD; HR=5.17, 95% CI=1-26.75, P<0.05), or after laparotomy for ectopic pregnancy (EP; HR=50.2, CI=1.43-1766.87, P<0.05) and need for invasive mechanical ventilation (IMV; HR=35.5, CI=3.14-401.75, P<0.05) or inotropic support (IS; HR=12.06, CI=1.96-74.19, P<0.05) increased while admission after VD (HR=0.10, CI=0.01-0.73, P<0.05) decreased mortality risk. Interpretation & conclusions HDP and PPH were the most common maternal presentations in obstetric ICUs. Maternal mortality was low. Patients with heart diseases, IMV/IS requirement, and those admitted after IUFD or laparotomy for EP had increased, while patients admitted after VD had decreased mortality risk in the ICU.