The High Dependency Unit in the Management of Critically Ill Obstetric Patients in Low Resource Countries

Abstract

The care of the obstetric population requiring critical care at the intensive care unit is associated with challenges that have made the establishment of obstetric high dependency units (HDU) a priority in the developed, unlike low resource countries.

The objective was to evaluate the need to establish obstetric HDUs in low-resource countries.
The study was a retrospective descriptive study of obstetric patients admitted in the intensive care unit of the University of Ilorin Teaching Hospital from 1st January 2010 to30th June 2013. Those that were suitable for management at HDUs were compared with those who needed ICU care. The statistical analysis was with SPSS version 20 with p-values, x2, and odds ratio; p-value <0.05 was considered significant.

All the 52 patients were postpartum; 16(30.8%) were suitable for HDU care. Of the HDU eligible patients, 11(68.8%) were of low social class, 12(75%) were booked, 11(68.8%) had no further complication at ICU and mortality was 1(6.25%). Compared to those who needed ICU care, there were no statistical significance in maternal age, parity, duration of ICU admission and total cost of ICU care. There were more cases with statistical significance of organ involvement (p<0.001), severity of Glasgow coma score at admission (p<0.001), further complications at ICU (p<0.001) and maternal mortality (p<0.001) among those needing ICU care compared to
those needing HDU care.

In conclusion, the establishment of the HDU will reduce cost and the burden on the few ICUs in low-resource countries without increasing maternal mortality.