Clinico-Epidemiological Profile of Obstetric Admissions to Intensive Care Unit and High Dependency Unit of a Tertiary Care Hospital

Background: Obstetric critical illness can happen in the antenatal, intrapartum and/or postpartum period and may require intensive monitoring and organ-supportive care. High Dependency Units (HDUs) and Intensive Care Units (ICUs) are important in the care of women with severe obstetric and medical complications. Material and Methods: This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Kota from 1st October 2023 to 31st December 2024. All eligible obstetric patients admitted to the HDU and/or to the ICU (direct admission or transfer from wards or other departments) were included. Maternal characteristics, indications for critical-care admission, interventions, length of stay, maternal outcomes, causes of death and neonatal/perinatal outcomes were evaluated. All data was analysed using SPSS and presented as frequencies, percentages and mean ± SD. Results: Of 11,880 labour-room admissions, 1,208 (10.16%) needed HDU/ICU care. Most women were aged 21–30 years (53.31%), from rural areas (75.74%), and were referred cases (75.74%). 56.62% of admissions were for postpartum complications. The most common indications were hypertensive disorders of pregnancy (34.25%), antepartum haemorrhage (16.19%) and anaemia (14.73%). Blood and blood-product transfusion was the commonest intervention (45.76%) followed by administration of magnesium sulphate (32.64%). The average length of critical care stay was 2.92 days. The overall recovery rate was 91.39%, near-miss morbidity rate was 3.90% and mortality was 1.57%. The major cause of maternal death was haemorrhagic shock (36.84%). Of 1072 neonates, 79.47% survived till day 7 and 63.72% of livebirths were admitted to the NICU. Conclusion: There was a significant critical care burden associated with obstetric HDU/ICU admissions, with hypertensive disorders of pregnancy, obstetric haemorrhage and anaemia all playing a significant role. The high referral and rural population emphasizes the need for prompt recognition, timely referral and prompt multidisciplinary management. Enhancing obstetric HDU/ICU services could have a positive impact on maternal and perinatal outcomes.

Keywords: Obstetric critical care, Intensive Care Unit, High Dependency Unit, Maternal morbidity, Maternal mortality.