International journal of

ADVANCED AND APPLIED SCIENCES

EISSN: 2313-3724, Print ISSN:2313-626X

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 Volume 6, Issue 7 (July 2019), Pages: 104-111

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 Original Research Paper

 Title: Clinical profile and outcomes of obstetric patients requiring intensive care: An audit of patients admitted to a tertiary care hospital in Riyadh, Saudi Arabia

 Author(s): Rabia Waheed 1, Lulu Abdullah Al-Nuaim 1, *, Hessa Mohamed AlOthman 1, Lamya Salah Alnaim 2, Hatim DakailAllah ALMalke 3, Johara Abdullah ALMotawa 1, Razaq Oladipo Masha 1, Ahmed Abdulwahab Abdukarim 1, Seifeldin Taha Yousif 1

 Affiliation(s):

 1Department of Obstetrics and Gynecology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
 2Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
 3Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

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 * Corresponding Author. 

  Corresponding author's ORCID profile: https://orcid.org/0000-0003-1531-1090

 Digital Object Identifier: 

 https://doi.org/10.21833/ijaas.2019.07.014

 Abstract:

Although required infrequently, intensive care for obstetric patients is challenging due to its un-predictive nature, knowing the etiology and consequent therapeutic management of such patients is very important for obstetricians and intensivists to improve the quality of care related to such conditions. The objective of this study was to study the spectrum of disease, required interventions and outcome of the obstetric patients admitted to Surgical Intensive Care Unit (SICU) of King Khalid University Hospital, Riyadh, Saudi Arabia. In this retrospective study, the medical records of obstetric patients admitted to SICU over a period of 5 years (January 2011 to December 2015) were reviewed. Of the 18,695 obstetric patients, only 50 (0.267%) required SICU admission. Two (4%) patients were admitted from the emergency, 28 (56%) from obstetric ward, 20 (40%) from labor room. Comorbid conditions were present in 20 (40%) patients. The commonest cause for SICU admission was obstetric hemorrhage (54%) followed by hypertension (16%) and pulmonary embolism (8%). Cesarean section was performed in 34 (68%) patients. There was no mortality. Mean lengths of stay in SICU and hospital were 3.08±3.99 (range: 1-25) and 12.7±12.6 (range: 3-90) days, respectively. A very low SICU admission rate with no mortality among our obstetric patients could be related to good antenatal care, early admissions of patients and employing a multidisciplinary approach. 

 © 2019 The Authors. Published by IASE.

 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

 Keywords: Obstetric hemorrhage, Hypertension, Surgical ICU

 Article History: Received 7 March 2019, Received in revised form 25 May 2019, Accepted 27 May 2019

 Acknowledgement:

We thank all the technical staff who helped in preparing the data participated in this study. This work was supported by the College of Medicine Research Center, Deanship of Scientific research, King Saud University, Riyadh, Kingdom of Saudi Arabia.

 Compliance with ethical standards

 Conflict of interest:  The authors declare that they have no conflict of interest.

 Citation:

 Waheed R, Al-Nuaim LA, and AlOthman HM et al. (2019). Clinical profile and outcomes of obstetric patients requiring intensive care: An audit of patients admitted to a tertiary care hospital in Riyadh, Saudi Arabia. International Journal of Advanced and Applied Sciences, 6(7): 104-111

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 Figures

 Fig. 1

 Tables

 Table 1 Table 2 Table 3

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 References (46) 

  1. Agarwal K, Mukhopadhyay P, Dahiya K, Hooda R, Sanghi S, Narsaria K, and Garg G (2017). Obstetric admissions to the critical care unit: A one year experience at a tertiary care referral centre of the developing country. International Journal of Medicine, 5(1): 113-119. https://doi.org/10.14419/ijm.v5i1.7446   [Google Scholar]
  2. Aldawood A (2011). Clinical characteristics and outcomes of critically ill obstetric patients: A ten-year review. Annals of Saudi Medicine, 31(5): 518-522. https://doi.org/10.4103/0256-4947.84631   [Google Scholar] PMid:21911991 PMCid:PMC3183688
  3. Al-Jabari AS, Al-Meshari AA, Takrouri MS, and Seraj MA (2001). Gynecology and obstetrical conditions requiring intensive care admission. Saudi Medical Journal, 22(11): 980-983.   [Google Scholar]
  4. Al-Suleiman SA, Qutub HO, Rahman J, and Rahman MS (2006). Obstetric admissions to the intensive care unit: A 12-year review. Archives of Gynecology and Obstetrics, 274(1): 4-8. https://doi.org/10.1007/s00404-004-0721-z   [Google Scholar] PMid:16432668
  5. Anwari JS, Butt AA, and Al-Dar MA (2004). Obstetric admissions to the intensive care unit. Saudi Medical Journal, 25(10): 1394-1399.   [Google Scholar]
  6. Bajwa SJS and Kaur J (2014). Critical care challenges in obstetrics: An acute need for dedicated and co-ordinated teamwork. Anesthesia, Essays and Researches, 8(3): 267-269. https://doi.org/10.4103/0259-1162.143107   [Google Scholar] PMid:25886319 PMCid:PMC4258962
  7. Chawla S, Nakra M, Mohan S, Nambiar BC, Agarwal R, and Marwaha A (2013). Why do obstetric patients go to the ICU? A 3-year-study. Medical Journal Armed Forces India, 69(2): 134-137. https://doi.org/10.1016/j.mjafi.2012.08.033   [Google Scholar] PMid:24600086 PMCid:PMC3862664
  8. Cheng C and Raman S (2003). Intensive care use by critically ill obstetric patients: A five-year review. International Journal of Obstetric Anesthesia, 12(2): 89-92. https://doi.org/10.1016/S0959-289X(02)00154-1   [Google Scholar]
  9. De Greve M, Van Mieghem T, Van Den Berghe G, and Hanssens M (2016). Obstetric admissions to the intensive care unit in a tertiary hospital. Gynecologic and Obstetric Investigation, 81(4): 315-320. https://doi.org/10.1159/000431224   [Google Scholar] PMid:26963752
  10. Ebirim LN and Ojum S (2012). Admissions of obstetric patients in the Intensive Care Unit: A 5 year review. Saudi Journal of Medicine and Medical Sciences, 3: 741-744.   [Google Scholar]
  11. Garg P and Tripatti T (2018). A study to know clinical charchteristics and outcome of obstetric patients requiring ICU admission. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7(7): 2639-2644. https://doi.org/10.18203/2320-1770.ijrcog20182481   [Google Scholar]
  12. Gatt S (2003). Pregnancy, delivery and the intensive care unit: Need, outcome and management. Current Opinion in Anesthesiology, 16(3): 263-267. https://doi.org/10.1097/00001503-200306000-00004   [Google Scholar] PMid:17021469
  13. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, and Murray CJ (2010). Maternal mortality for 181 countries, 1980–2008: A systematic analysis of progress towards millennium development goal 5. The lancet, 375(9726): 1609-1623. https://doi.org/10.1016/S0140-6736(10)60518-1   [Google Scholar]
  14. Hutcheon JA, Lisonkova S, and Joseph KS (2011). Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Practice and Research Clinical Obstetrics and Gynaecology, 25(4): 391-403. https://doi.org/10.1016/j.bpobgyn.2011.01.006   [Google Scholar] PMid:21333604
  15. Jain M and Modi J (2015). An audit of obstetric admissions to intensive care unit in a medical college hospital of central India: Lessons in preventing maternal morbidity and mortality. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 4(1): 140-145. https://doi.org/10.5455/2320-1770.ijrcog20150225   [Google Scholar]
  16. Jayaratnam S, De Costa C, and Howat P (2011). Developing an assessment tool for maternal morbidity ‘near‐miss’–A prospective study in a large Australian regional hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology, 51(5): 421-425. https://doi.org/10.1111/j.1479-828X.2011.01330.x   [Google Scholar] PMid:21806590
  17. Karnad DR and Guntupalli KK (2004). Critical illness and pregnancy: Review of a global problem. Critical Care Clinics, 20(4): 555-576. https://doi.org/10.1016/j.ccc.2004.05.001   [Google Scholar] PMid:15388189
  18. Keizer JL, Zwart JJ, Meerman RH, Harinck BI, Feuth HD, and van Roosmalen J (2006). Obstetric intensive care admissions: A 12-year review in a tertiary care centre. European Journal of Obstetrics and Gynecology and Reproductive Biology, 128(1-2): 152-156. https://doi.org/10.1016/j.ejogrb.2005.12.013   [Google Scholar] PMid:16443319
  19. Lalonde A (2012). Prevention and treatment of postpartum hemorrhage in low‐resource settings. International Journal of Gynecology and Obstetrics, 117(2): 108-118. https://doi.org/10.1016/j.ijgo.2012.03.001   [Google Scholar] PMid:22502595
  20. Lataifeh I, Amarin Z, Zayed F, Al-Mehaisen L, Alchalabi H, and Khader Y (2010). Indications and outcome for obstetric patients' admission to intensive care unit: A 7-year review. Journal of Obstetrics and Gynaecology, 30(4): 378-382. https://doi.org/10.3109/01443611003646298   [Google Scholar] PMid:20455722
  21. Lawton BA, Wilson LF, Dinsdale RA, Rose SB, Brown SA, Tait J, and McCaw A (2010). Audit of severe acute maternal morbidity describing reasons for transfer and potential preventability of admissions to ICU. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50(4): 346-351. https://doi.org/10.1111/j.1479-828X.2010.01200.x   [Google Scholar] PMid:20716262
  22. Leung NY, Lau AC, Chan KK, and Yan WW (2010). Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit: A 10-year retrospective review. Hong Kong Medicine Journal, 16(1): 18-25.   [Google Scholar]
  23. Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, and Lopez AD (2011). Progress towards millennium development goals 4 and 5 on maternal and child mortality: An updated systematic analysis. The Lancet, 378(9797): 1139-1165. https://doi.org/10.1016/S0140-6736(11)61337-8   [Google Scholar]
  24. Mahutte NG, Murphy-Kaulbeck L, Le Q, Solomon J, Benjamin A, and Boyd ME (1999). Obstetric admissions to the intensive care unit. Obstetrics and Gynecology, 94(2): 263-266. https://doi.org/10.1097/00006250-199908000-00021   [Google Scholar] PMid:10432140
  25. Mjahed K, Hamoudi D, Salmi S, and Barrou L (2006). Obstetric patients in a surgical intensive care unit: Prognostic factors and outcome. Journal of Obstetrics and Gynaecology, 26(5): 418-423. https://doi.org/10.1080/01443610600720188   [Google Scholar] PMid:16846867
  26. MOH (2013). The yearly health book statistics 2013. Ministry of Health Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.   [Google Scholar]
  27. Motiang M (2017). Obstetric patients admitted to the intensive care unit of Dr George Mukhari academic hospital, Ga-Rankuwa, South Africa. Southern African Journal of Critical Care, 33(1): 12-14.   [Google Scholar]
  28. Mowafy AH and Mashhour KS (2010). Clinical characteristics and outcomes of obstetric patients requiring ICU admission. The Medical Journal of Cairo University, 78(2): 835-844.   [Google Scholar]
  29. Ng VK, Lo TK, Tsang HH, Lau WL, and Leung WC (2014). Intensive care unit admission of obstetric cases: A single centre experience with contemporary update. Hong Kong Medicine Journal, 20(1): 24-31. https://doi.org/10.12809/hkmj133924   [Google Scholar]
  30. Okafor UV and Aniebue U (2004). Admission pattern and outcome in critical care obstetric patients. International Journal of Obstetric Anesthesia, 13(3): 164-166. https://doi.org/10.1016/j.ijoa.2004.04.002   [Google Scholar] PMid:15321395
  31. Orsini J, Butala A, Diaz L, Muzylo E, Mainardi C, and Kastell P (2012). Clinical profile of obstetric patients admitted to the medical-surgical intensive care unit (MSICU) of an inner-city hospital in New York. Journal of Clinical Medicine Research, 4(5): 314-317. https://doi.org/10.4021/jocmr1079w   [Google Scholar]
  32. Pattnaik T, Samal S, and Behuria S (2015). Obstetric admissions to the intensive care unit: A five year review. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 4(6): 1914-1917. https://doi.org/10.18203/2320-1770.ijrcog20151285   [Google Scholar]
  33. Pollock W, Rose L, and Dennis CL (2010). Pregnant and postpartum admissions to the intensive care unit: A systematic review. Intensive Care Medicine, 36(9): 1465-1474. https://doi.org/10.1007/s00134-010-1951-0   [Google Scholar] PMid:20631987
  34. Qureshi R, Irfan Ahmed S, Raza A, Khurshid A, and Chishti U (2016). Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan. JRSM Open, 7(11): 1-8. https://doi.org/10.1177/2054270416663569   [Google Scholar] PMid:27895930 PMCid:PMC5117160
  35. Rathod AT and Malini KV (2016). Study of obstetric admissions to the intensive care unit of a tertiary care hospital. The Journal of Obstetrics and Gynecology of India, 66(1): 12-17. https://doi.org/10.1007/s13224-015-0750-5   [Google Scholar] PMid:27651571 PMCid:PMC5016396
  36. Rossi AC, Lee RH, and Chmait RH (2010). Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: A systematic review. Obstetrics and Gynecology, 115(3): 637-644. https://doi.org/10.1097/AOG.0b013e3181cfc007   [Google Scholar] PMid:20177297
  37. Sharara HA, Rhaman LNA, Ummunnisa F, Aboubaker N, Abdullah MM, and Shaikh N (2014). Obese nulliparous women and the risk for maternal and fetal complications. Open Journal of Obstetrics and Gynecology, 4: 239-242. https://doi.org/10.4236/ojog.2014.45039   [Google Scholar]
  38. Sharma R, Gupta BD, Dubey K, and Kanash S (2016). Why do the obstetric patients go to the ICU/HDU? A retrospective observational study. Imperial Journal of Interdisciplinary Research, 2(3): 334-337.   [Google Scholar]
  39. Steegers EA, Von Dadelszen P, Duvekot JJ, and Pijnenborg R (2010). Pre-eclampsia. The Lancet, 376(9741): 631-644. https://doi.org/10.1016/S0140-6736(10)60279-6   [Google Scholar]
  40. Sujata P, Sahoo J, Sahoo G, and Sahu MC (2016). Evaluation of obstetric admissions to intensive care unit (ICU) of a tertiary care Indian teaching hospital. International Journal of Pharmaceutical Sciences Review and Research, 36(1): 264-266.   [Google Scholar]
  41. Taylor DJ (2012). Professional leadership in obstetrics and gynecology and its contribution to millennium development goal 5. International Journal of Gynecology and Obstetrics, 119: S42-S44. https://doi.org/10.1016/j.ijgo.2012.03.015   [Google Scholar] PMid:22884822
  42. Van den Broek NR and Falconer AD (2011). Maternal mortality and millennium development goal 5. British Medical Bulletin, 99(1): 25-38. https://doi.org/10.1093/bmb/ldr033   [Google Scholar] PMid:21893492
  43. Verma D and Rathore AM (2014). Obstetric admissions to the intensive care unit of a tertiary hospital in northern India. International Journal of Biomedical Research, 5(9): 539-542. https://doi.org/10.7439/ijbr.v5i9.399   [Google Scholar]
  44. WHO (2010). Trends in maternal mortality: 1990 to 2008. World Health Organization, Geneva, Switzerland.   [Google Scholar]
  45. WHO (2012). Maternal mortality. World Health Organization, Geneva, Switzerland.   [Google Scholar]
  46. Zwart JJ, Dupuis JR, Richters A, Öry F, and van Roosmalen J (2010). Obstetric intensive care unit admission: A 2-year nationwide population-based cohort study. Intensive Care Medicine, 36(2): 256-263. https://doi.org/10.1007/s00134-009-1707-x   [Google Scholar] PMid:19902177 PMCid:PMC2809313