Obstetric Admissions in the Intensive Care Unit of a Tertiary Care Hospital: Steps for Better Outcome

Abstract

Background: Maternal mortality is a crucial issue throughout the world. In Bangladesh, Maternal mortality ratio was  196 (uncertainty range = 159-234) per 100 000 live births. Maternal deaths occurred on the day of delivery is 30% and  6% on one day post-delivery.1 it is necessary to point out those factors for improvement.  Objective: This study was focused to identify those factors, attributed to morbidity and mortality among the pregnant  women and women in the postpartum period , who needed ICU admission.  Methods: This study is a retrospective observational study from January 2024 to December 2025 (two years) in a  tertiary care privet hospital, Dhaka. In the study period, 1697 patients got admitted in the two unit of ICU (7+8=15) 15  beds in a same hospital. Total of 57 patients were enrolled in this study.  Results: Mean age of patients was 27.87 ± 7.62 years. Most of the patients got admitted in ICU, during postpartum  period {42(73.68%)}. Indications for ICU admission were hypoxemic respiratory failure (77.19%), resp distress  (57.89%), pulmonary oedema (38.59%), fluid overload (45.61%), & shock (36.84%). Among the study population,  57.89% received NIV, 40.35% got conventional oxygen, 15.78% were on MV, 10.52% on HFNC, 40.35% required  vasopressor support, 10.52% needed dialysis & 29.82% needed transfusion. Diagnoses were divided as obstetric and  non-obstetric types. Obstetric diagnoses were pregnancy-induced hypertension (n=20, 35.08%), eclampsia (n=15,  26.31%), postpartum hemorrhage (n=16, 28.07%), HELLP syndrome (n=6, 10.52%), peripartum cardiomyopathy  (n=4, 7.01%), intra uterine death with MODS (n=2, 3.50%), ruptured ectopic pregnancy (n=7, 12.28%), and abortion  (n= 2, 3.50%). Non-obstetric diagnoses were pulmonary oedema (n=15, 26.31%), AKI (n=10, 17.54%), TRALI (n=10,  17.54%), ARDS (n=4, 7.01%), DIC: 5(8.77%), cerebral venus sinus thrombosis: 2(3.50%), MODS:7(12.28%), Sepsis  (n=2, 3.50%), Dengue (n=2, 3.50%), PRES (n=5, 8.77%), congenital methemoglobinemia (n=1, 1.75%), TTP (n=1,  1.75%), and acute pancreatitis (n=2, 3.50%). Non-urban patients were younger than urban patients (25.24 ± 5.57 vs  31.62 ± 5.87, p = 0.031) and higher number of primipara pregnancies among non-urban patients than urban group (  23 vs 2, p = 0.013). Non-urban patients’ length of hospital stays and ICU stay were longer and had more MODS  (15.38%) at admission and mortality rate (12.82%) compared to urban population and APACHE II scoring was higher  in non-urban (10.35 ± 3.14, vs 6.43 ± 2.59, p = 0.002). Higher severity of metabolic acidosis and lower P/F ratio  and higher serum lactate were observed in non-survivor in compared to survivor group. SOFA score was significantly  higher in nonsurvivors compared to survivors (6.5 ± 0.83 vs 2.60 ± 1.07; p < 0.0001). The APACHE II score was also  significantly higher in non-survivors compared to survivors’ group (15.3 ± 1.09 vs 7.7 ± 0.6; p < 0.0001). The mean  hospital stay was significantly longer in nonsurvivors group compared to survivors (9.0 ± 4.9 Vs 5.3 ± 2.4; p < 0.0001).  Conclusions: To improve the outcome, attention should be paid to the non-urban early risk assessment, emergency  maternal health care and transportation system and increase awareness about obstetric critical care in non-urban area.  Bangladesh Crit Care J September 2026; 14 (2): 98-103