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Obstetric and gynaecological admissions in an intensive care unit of a Nigerian teaching hospital: a 5-year review
Abstract
Background: Management of critically ill women in intensive care units (ICU) is crucial in reducing maternal mortality. This study sought to determine the ICU obstetric and gynaecology utilization rate, indications for admissions, assess the outcome and risk factors associated with mortality.
Design/ settings: A retrospective descriptive study of admissions in a multidisciplinary ICU setting in a University Teaching Hospital in Nigeria.
Methods: Records of obstetric and gynaecological patients admitted to the ICU over a 5-year period were entered into a computer. Data included demographic and clinical characteristics of the patients, interventions performed and outcomes of patients' ICU care. Data was analysed using SPSS version 20 for windows.
Results: The MMR was 870 per 100,000 live births. The incidence of obstetric and gynaecological admissions to the ICU was 5.2% (37/706) of all admissions. 20 (58%) were obstetric cases, mostly severe PET/eclampsia15 (40.5%), 42% of the women were admitted for complications of gynaecological procedures. Commonest complication was adult respiratory distress syndrome (ARDS). The mortality was 16 (43%) overall, 10 (62.5%) were obstetric cases mainly PET/eclmpsia (56%). The likelihood of Obstetric mortality was twice that of gynaecological mortality (OR 2.5, 95% CI 0.99 – 6.16, P<0.026). Factors related to poor outcomes were 2 or more interventions (P=0.001).
Conclusion: Obstetric and gynaecology ICU utilization was low considering the high MMR. The major indication for admission was severe PET/eclampsia. The need for ventilatory support may predict poor outcome. There is need for dedicated obstetrics and gynaecology ICU to make access easier for Near Miss cases.
Keywords: Obstetrics; Critical care; Gynaecology; Intensive care unit
