Open Access Open Access  Restricted Access Subscription Access

Study of Maternal and Perinatal Outcome in Patients in High Dependency Unit (HDU) in a Tertiary Care Centre


Affiliations
1 Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik - 422003, Maharashtra, India
 

Background: It was a retrospective observational study to know demographic factors, indication of High Dependency Unit (HDU) admission, course of stay, maternal and perinatal outcome in patients admitted in HDU in a tertiary care centre. Introduction: Pregnancy and delivery are physiological events. But, they have the potential for life threatening complications. Maternal mortality is an important indicator that reflects quality and adequacy of health care services. Timely intervention and early treatment in patients with high risk pregnancy may reduce further complications i.e. Need of intensive monitoring, morbidity and mortality. Methodology: Total 213 cases with high risk pregnancy admitted in HDU, were included in present study after satisfying inclusion and exclusion criteria. We studied demographic factors, indication of HDU admission and course of stay as well as maternal and perinatal outcome. Results: Majority of the patients i.e. 99 patients (46.48%) were in the age group of 21-25 years. 85 patients i.e. 39.91% were Primigravida while 74 patients i.e. 34.74% were second gravida. Maximum numbers of patients i.e. 173 patients (81.22%) were unregistered. A majority of patients i.e. 136 patients (63.85%) admitted in the HDU had gestational age <37 weeks while 68 patients i.e. 31.93% had gestational age between 37 to 40 weeks. Out of 213 patients, 146 patients i.e. 68.54% had obstetric complications while 67 patients i.e. 31.46% had medical complications. Pre-eclampsia, seen in 74 patients i.e. 34.74%, was the commonest obstetric indication for admission to HDU. Anemia seen in 22 patients i.e. 10.32% was the most common medical indication for HDU admission. Out of 213 patients, 101 patients i.e. 47.42% delivered vaginally, 84 patients i.e. 39.44% underwent caesarean section, 11 patients i.e. 5.16% had abortion whereas 11 patients i.e. 5.16% had ectopic pregnancy. Out of 185 deliveries 131 neonates were perfectly healthy, 37 had still births, 17 needed NICU admission and 9 had Neonatal deaths. Mean HDU stay was 3.31 days. 14 patients out of 213 required ICU care for further management. Mean ICU stay in medical complication group was 0.36 and that for obstetric complication group was 0.19. Out of 213 patients, maternal mortality occurred in 3 patients. Conclusion: Lack of health awareness and delayed referral to tertiary care centre seem to be a major reason for HDU and ICU admission and further maternal and neonatal morbidity and mortality. Timely antenatal registration, antenatal follow ups, prophylactic intervention and anticipation of intensive care can change the scenario hence leading to a decreased maternal morbidity and mortality.

Keywords

High Dependency Unit (HDU), ICU, Maternal Morbidity, Maternal Mortality.
Font Size

User
Notifications

  • Dattaray C, Mandal D, Shankar U, Bhattacharya P, Mandal S. Obstetric patients requiring high-dependency unit admission in a tertiary referral centre, International Journal of Critical illness and injury Science. 2013 March; 1:31-35. https://doi.org/10.4103/2229-5151.109416. PMid: 23724382, PMCid: PMC3665116.
  • Pattanaik T, Samal S, Behuria S. Obstetric admissions to the intensive care units: A five year review, International Journal of Reproduction, Contraception, Obstetrics and Gynaecology. 2015 Dec; 6:1914-1917. https://doi.org/10.18203/2320-1770.ijrcog20151285.
  • Park K. Park’s Textbook of Preventive and Social Medicine. 25th ed. Mumbai: Bhanot; Feb. 2019 p.611-12.
  • State statistics, Maternal Mortality Ratio. NITI Aayog, Government of India. Accessed on 2018 March. Available from http://niti.gov.in/content/maternal-mortality-ratio-mmr-100000-live-births.
  • Maternal Health. UNICEF INDIA. Accessed on 2016 Oct. Available from http://unicef.in/Whatwedo/1/Maternal-Health.
  • Fact Sheets. Maternal Mortality. World Health Organisation. Accessed on 2018 Feb. Available from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
  • Marques, Castenheira S, Periera L, Pinto F, Carvalhas J, Martires E. Obstetric high dependency unit admission: A four year retrospective study, European Journal of Anaesthesiology. 2014 June; 31:134-136. https://doi.org/10.1097/00003643-201406001-00536.
  • Gilbert TT, Smulian JC, Martin AA, Ananth CV, Scorza W, Scardella AT, et al. Obstetric admissions to the intensive care unit: Outcomes and severity of illness, Obstet Gynaecol. 2003; 102:897-903. https://doi.org/10.1016/S0029-7844(03)007671. https://doi.org/10.1097/00006250-200311000-00004.
  • Masood A., Gaballah K., Omar Z. Maternal and Foetal Outcome among patients requiring High Dependency Unit admission: A Five Year Prospective Study, Obstetrics and Gynecology International Journal. 2018 Feb 26; 9(I-2018):89-93. https://doi.org/10.15406/ogij.2018.09.00310.
  • Bevan R, Venkatesh B, Freebairn R. Intensive Care Medicine Training in Australia and New Zealand: A Clarification, Critical Care Medicine. 2015 Nov; 43(11):e540. https://doi.org/10.1097/CCM.0000000000001242. PMid:26468732.
  • Ryan M, Hamilton V, Bowen M, et al. The role of a high-dependency unit in a regional obstetric hospital, Anaesthesia. 2000; 55:1155-8. https://doi.org/10.1046/j.1365-2044.2000.01627.x. PMid:11121922.
  • Monsalve Germán A, Martínez Catalina M., Gallo Tatiana, González María Virginia, Arango Gonzalo, Upegui Alejandro et al . Maternal Critical Care: Outcomes and Patient Characteristics in a Combined Obstetric High Dependency Unit in Medellín, Colombia, Rev. Colomb. Anestesiol. 2011 July; 39(2):190-205. https://doi.org/10.5554/rca.v39i2.96/suffix.
  • Saravanakumar K, Davies L, Lewis M, Cooper GM. High dependency care in an obstetric setting in the UK. Anaesthesia. John Wiley & Sons, Ltd (10.1111); 2008. https://doi.org/10.1111/j.1365-2044.2008.05581.x. PMid:18821887.
  • Levels of critical care for adult patients, Nursing in Critical Care. 2003 Apr; 8(2):90. https://doi.org/10.1046/j.1478-5153.2003.t01-1-00001.x.
  • Guidelines for the Critically Ill Woman in Obstetrics Version 1.1 2014, Aug: 7.
  • Sharma R, Gupta BD, Dubey K, Kanash S. Why Do The Obstetric Patients Go To The ICU/HDU ? A Retrospective Observational Study, Imperial Journal of Interdisciplinary Research. 2016; 2(3):334-337.

Abstract Views: 18

PDF Views: 0




  • Study of Maternal and Perinatal Outcome in Patients in High Dependency Unit (HDU) in a Tertiary Care Centre

Abstract Views: 18  |  PDF Views: 0

Authors

Padmaja Satyen Joshi
Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik - 422003, Maharashtra, India
Manasi Harish Kathaley
Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik - 422003, Maharashtra, India
Rucha Umesh Dashrathi
Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik - 422003, Maharashtra, India
Shreeda Uday Prasade
Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik - 422003, Maharashtra, India

Abstract


Background: It was a retrospective observational study to know demographic factors, indication of High Dependency Unit (HDU) admission, course of stay, maternal and perinatal outcome in patients admitted in HDU in a tertiary care centre. Introduction: Pregnancy and delivery are physiological events. But, they have the potential for life threatening complications. Maternal mortality is an important indicator that reflects quality and adequacy of health care services. Timely intervention and early treatment in patients with high risk pregnancy may reduce further complications i.e. Need of intensive monitoring, morbidity and mortality. Methodology: Total 213 cases with high risk pregnancy admitted in HDU, were included in present study after satisfying inclusion and exclusion criteria. We studied demographic factors, indication of HDU admission and course of stay as well as maternal and perinatal outcome. Results: Majority of the patients i.e. 99 patients (46.48%) were in the age group of 21-25 years. 85 patients i.e. 39.91% were Primigravida while 74 patients i.e. 34.74% were second gravida. Maximum numbers of patients i.e. 173 patients (81.22%) were unregistered. A majority of patients i.e. 136 patients (63.85%) admitted in the HDU had gestational age <37 weeks while 68 patients i.e. 31.93% had gestational age between 37 to 40 weeks. Out of 213 patients, 146 patients i.e. 68.54% had obstetric complications while 67 patients i.e. 31.46% had medical complications. Pre-eclampsia, seen in 74 patients i.e. 34.74%, was the commonest obstetric indication for admission to HDU. Anemia seen in 22 patients i.e. 10.32% was the most common medical indication for HDU admission. Out of 213 patients, 101 patients i.e. 47.42% delivered vaginally, 84 patients i.e. 39.44% underwent caesarean section, 11 patients i.e. 5.16% had abortion whereas 11 patients i.e. 5.16% had ectopic pregnancy. Out of 185 deliveries 131 neonates were perfectly healthy, 37 had still births, 17 needed NICU admission and 9 had Neonatal deaths. Mean HDU stay was 3.31 days. 14 patients out of 213 required ICU care for further management. Mean ICU stay in medical complication group was 0.36 and that for obstetric complication group was 0.19. Out of 213 patients, maternal mortality occurred in 3 patients. Conclusion: Lack of health awareness and delayed referral to tertiary care centre seem to be a major reason for HDU and ICU admission and further maternal and neonatal morbidity and mortality. Timely antenatal registration, antenatal follow ups, prophylactic intervention and anticipation of intensive care can change the scenario hence leading to a decreased maternal morbidity and mortality.

Keywords


High Dependency Unit (HDU), ICU, Maternal Morbidity, Maternal Mortality.

References





DOI: https://doi.org/10.18311/mvpjms%2F2019%2Fv6i1%2F23570