RESULTS
- The incidence of ICU admission was 0.77% (124 ICU admission/15982
total obstetric admission).
- Majority of patients were between 20-30 years (80.6%). Age was not
associated with outcome (p>0.05)
- 53.2% cases were unbooked and 55.6% patients were referred from
peripheral hospitals. All the outcomes were significantly worse in
referred patients except perinatal morbidity.
- More than one third of the patients were uneducated (39.5%) followed
by below high school (30.6%), high school-intermediate (21.8%) and
graduate (8.1%).The maternal mortality ,perinatal mortality and
prolonged ICU stay was higher in the uneducated patients .However a
significant association could be established only with prolonged ICU
stay (p=0.001) .
More than half of the patient belonged to lower class (66.9%)
followed by upper lower (29%) and lower middle class (4%). All the
outcomes were worst in patients of lower socioeconomic strata.
However, no significant (p>0.05) association could be
established.
- 67.7% of patients were multiparous. There was no significant
association found between parity and the outcomes.
- Admission to ICU was more common in postpartum period (88.7%) as
compared to antenatal period (11.3%).
- There was no delay present at any level in 25% cases. 75% of
patients had delay at single or multiple levels. Presence of delay was
significantly associated with prolonged ICU stay(p=0.001), maternal
mortality(p=0.003) and perinatal mortality (p=0.01). The association
of outcomes with presence or absence of delay and duration of delays
is depicted in Table 1and 2 and Figure 1.
- First level delay was present in 34.7% cases. Second level delay was
present in 50% cases and it was more than 4 hours in 16.9% patients.
Third level delay was present in 9.7% patients.
- Presence of 1st and 2nd level
delay and their increasing duration was significantly associated with
prolonged ICU stay (p=0.002) (p=0.01), maternal mortality
(p=0.001,0.004) and perinatal mortality (p=0.002.0.005).
- APACHE II score of 5-9 was most common (28.2%) and APACHE II score of
<4 was present only in 0.8% cases. Mean APACHE II score was
14.77±6.85. Table 3-4 depicts the comparison of APACHE II score with
delays and its association with outcomes.
- The post hoc test revealed that APACHE II score was significantly
(p<0.05) high in patients having delay of ≥24 hrs. APACHE II
score was significantly higher in the presence of
2nd level delay and it significantly increased as
the duration of delay increased (p=0.0001).
- High APACHE II score was significantly associated with length of ICU
stay(p=0.001), maternal mortality(p=0.001), perinatal
mortality(p=0.001) and length of hospital stay(p=0.008).
Most common indication for ICU admission was obstetrical hemorrhage
(37.1 %) followed by hypertensive disorders of pregnancy (25.8%).
- Blood and blood product transfusion (83.87%), mechanical ventilation
(66.12%) and the use of inotropic support (47.58%) were the major
interventions done. Surgical intervention was done in 25% cases in
association with other major interventions. Maternal mortality was
decreased in patients who had timely surgical intervention though no
significant association was found.
- About half of patients had ICU stay of >48 hours
(51.6%). Mean length of ICU stay was 3.18±2.40.
- Most common mode of delivery was cesarean section (58.1%).
- 38(30.6%) patients could not be saved.
.
- 30(29.12%) neonates had low Apgar score and needed NICU admission.
13(12.62%) patients had intrauterine death of the fetus and another
eight (7.76%) had early neonatal death in NICU. Five (4.85%)
patients had stillbirth. Perinatal morbidity was seen in 29.12%
subjects and perinatal mortality rate was 31.06%.
- The length of hospital stay was ≤7 days in 58.9% patients. Mean
length was 7.09±3.49 days.