Course and outcome of obstetric patients admitted to a University Hospital Intensive Care Unit
AbstractBackground: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available.
Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality.
Design: Retrospective patient file and ICU chart review.
Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed.
Setting: The ICU at The Aga Khan University Hospital, Nairobi, Kenya.
Results: Fourty two obstetric patients were admitted to the intensive care unit for the period of November 2003 to November 2010. This constituted 0.24% of deliveries and 1.25% of ICU admissions. Seventeen patients (52%) were in the age group 30 to 40 years, 13 patients (45%) were on their second pregnancy, and 15 patients (51%) were at term. Twenty five patients (76%) did not have prior co-morbidities. Indications for ICU admission were haemorrhage 15 (44%), sepsis nine (26%), help syndrome four (12%), thromboembolism two (6%), cardiomyopathy two (6%) and anaemia two (6%). The duration of stay ranged from two to 35 days with a mean of seven and median of two days. The outcome was19 patients (58%) were discharged home, 11 patients (33%) deaths and three patients (9%) were transferred to the National referral hospital- their survival outcome unknown. Case fatality rates were three of four patients (75%) for HELLP syndrome, four of fifteen patients (26.7%) for haemorrhage and three of ten patients (30%) after sepsis.
Conclusion: Critical Care Obstetrics is vital to the reduction of maternal morbidity. The main indications for ICU admission may be unpredictable but are largely preventable by improved and timely antenatal and intrapartum care. For the few but very sick patients requiring ICU care, a team based approach, as is achieved using the ‘closed’ care model may be feasible. Support to peripheral obstetric facilities via public private partnership initiatives is necessary. Healthcare planners and financiers should factor in critical care obstetric needs. Provision of a planned level of obstetric intensive care with the associated triage and referral infrastructure is a priority for the Region. As part of the drive towards Millennium Development Goal 5, health care financing models should support this essential component of life saving care, through all available channels including public private partnership.