Sahel Medical Journal (Jan 2012)
Intensive care management of critically ill obstetric patients at a tertiary institution in Northern Nigeria
Abstract
Background: To determine the pattern, intervention and outcome of critically ill obstetric patients admitted into the intensive care Unit (ICU). Methods: This is a retrospective analysis of the records of all critically ill hypertensive obstetric patients admitted into the ICU of Usmanu Danfodiyo University Teaching Hospital, Sokoto over a five-year period (January, 2001 - December, 2005). Results: Of the 5750 deliveries during the study period, 112 critically ill obstetric patients were admitted into the intensive care unit. This gives ICU admission rate of 19.5 per 1000 deliveries representing 1.94% and 33.7% of total deliveries and of all ICU admissions respectively. Eighty-one (72.3%) patients had hypertensive disorders in pregnancy comprising of intrapartum eclampsia 49(60.5%), severe preeclampsia 22(27.2%) and postpartum eclampsia 10(12.3%). Majority (78.6%) of the hypertensive disorders patients were primigravidae and only 19.8% of these had antenatal care (ANC). The other indications for ICU admission included respiratory insufficiency 14(12.5%) and major obstetric haemorrhage with cardiovascular haemodynamic instability 10(9.0). The modes of delivery were caesarean section 102 (91.1%), spontaneous vaginal delivery 8(7.1) and forceps delivery 2(1.8%). Three (6.0%) patients required ventilatory support which lasted less than 36 hours. The length of stay in the ICU ranged between 2 and 7 days. Maternal mortality rate was 12%. Conclusion: This data demonstrates a high proportion of obstetric patients with pregnancy induced hypertension requiring critical care therapy. The high maternal mortality underscores the need for intense health education on the utilisation of antenatal care services.
