To analyze the requirement of High Dependency Unit (HDU) and Intensive care Unit (ICU) in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome.
Retrospective observational study was carried out from October 2016 to September 2017 in Kasturba Hospital, Mother and Child Health Wing, Mahatma Gandhi Institute of Medical Sciences Sewagram placed in rural central India. Data related to indications for HDU/ICU admission, interventions required, length of stay and outcomes were collected, and results were analyzed.
Our obstetric HDU utilization rate was 11.2 per 1000 deliveries. Out of total 57 subjects 48 had no prior antenatal care. Majority (68.42%) were admitted in HDU with only obstetric reasons, while 31.57% required HDU for pre-existing medical diseases. The major obstetric indications were septicemia (35.08%) & PPH (29.08%) and hypertension was observed in 21.05% of women. Other less common causes included post-surgical acute kidney injury, APH, chorioamnionitis and pyelonephritis. Half of the women with pre-existing medical disease had cardiovascular problems. Patients with medical diseases had more pre-term labor (10 vs. 5; P ≤ 0.05), respiratory failure (9 vs. 2; P ≤ 0.05), cardiac failure (7 vs. 1; P ≤ 0.05), duration of stay more than 10 days (15 vs. 6; P ≤ 0.05), fetal growth restriction (6 vs. 3; P ≤ 0.05) and prolonged recovery time. Maternal mortality among these critically ill women was 12.28% and fetal mortality was 17.54%.
Establishment of well managed high dependency and intensive care unit in health care facilities dealing with high volumes of high-risk maternity cases reduces the maternal mortality significantly and results in improved maternal outcomes.